# Presentation: 326696

## Community of Interest for Patient Identifiers

**AGENDA**
- NHII’s Unique Health Information Identification Requirements - Soloman I. Appavu, SIG Leader
- Identification Methodology Currently in Use, its Challenges and Solutions - Michelle O’Connor, MPA, RHIA
- Security Standards that Protect Patient Identifiers and Identification Methods - Lori Reed-Fourquet
- Accurately Linking Health Information across NHII - John Halamka*,* MD
- Discussion on SIG Recommendations for Future Course of Action - Soloman I. Appavu

## President’s HIT Plan & Framework for Strategic Action

- President’s HIT Plan:
- “..Electronic Health Records will ensure that complete healthcare information is available”
- Completion and Adoption of Standards to store and share medical information electronically
- Framework for Strategic Action:
- Medical information would move seamlessly with consumers – Vision
- Regional Collaborations & National Health Information Network – Interconnect Clinicians

## Current Practice

- Provider-Specific Master Patient Index
- Facility Level Identifiers
- Enterprise Level Identifiers
- MPI Errors
- Local Level & Enterprise Level
- Problems
- Access to Incomplete Medical Records
- Increasing Fragmentation & Complexity
- Patient Care Risks, Wasted Dollars, Time & Staffing,  Disservice to Patients & their Longitudinal Record etc.

## Patient Identifier is an Integral Part of Patient Care

- Delivery of Care
- Positive identification of patients for blood transfusions, surgical procedures, invasive testing, medication administration
- Administrative Functions
- Eligibility verification, billing & reimbursement

## Patient Identifier is an Integral Part of Patient Information

- IDENTIFICATION OF INFORMATION
- Coordination of (Multi-disciplinary) Care Processes
- Medical Record Keeping & Information Management
- Administrative Functions
- Manual or Automated Linkage of Longitudinal or Lifelong Health Record
- Aggregation of Health Information

## Improve Efficiency & Health Status 

- Timely Access to Information
- Timely Care
- Continuity of Care
- Quality of Care
- Reduce Cost of Integration
- Optimum Use of Technology
- Improve the Health Status of the Nation

## Unique Patient Identifier

- Allow the various Players in the Healthcare  Systems to Perform their Respective Functions
**Admin., Financial, Clinical, Preventive, Research, etc.**
- Accurately Identify an Individual &Access an Individual’s Health Information
**Within an Organization, Across Multiple Organizations or Across the Industry**
- Enable the Multi-Disciplinary Care Processes
- Provide a Longitudinal View of Patient Data
- Facilitate the Continuity of Care
- Help Protect the Privacy of Health Information

## Unique Patient Identifiers Provide An Architectural Framework For Healthcare

- A Comprehensive Framework
- Provider ID, Health Plan/Payer ID, Employer ID, Patient ID
- All Players Within the Healthcare System Work Together
- Improve the Overall Efficiency of the Healthcare System
- Enhance the Overall Health Status of the Nation

## CURRENT MPI ERROR RATES AMONG PROVIDERS BY SIZE

- 100K TO 500K Records	4 – 7%
- 1M TO 5M	Records	9-12%
- >5M Records			>14%
- Evaluation of 300 MPIs (1/3rd single provider) from 2000 to 2003
- 2 Facilities out of 300 		<2%
- 98% of providers 		Exceeded 2%
- 55% of large facilities 		>15%
- 1/4th 				>10%
- _Source_: *Initiate Systems, Inc.*

## Discussion Questions

**Will access to incomplete EHR hurt patient care?**
**Current record keeping, information management and patient care practices are based on patient identifiers. Should we use two (2) different methods; one at provider level and another at national level? **
**Can we enhance the use of patient identifiers to protect privacy, increase the quality of care, reduce cost, achieve efficiency and meet our objectives? **
**Lessons learned: Do not overlay the technology without changing the underlying processes ( NHII ’04 speakers: John Chamber, Helen Darling, etc.)**
**MPI errors & inefficiencies: computer will run faster and multiply the errors and inefficiencies exponentially.  What will be the quality of our linkage? **
**Can we leverage from the current momentum and leadership to accomplish our goal the right way?**

## SIG RECOMMENDATIONS

- Build on Existing Infrastructure
**HIM/HIS/SDOs/Developers/Payers/Providers/Users**
**JCAHO/Professional Standards/Policies & Procedures**
**Current demonstration projects use global MPIs **
**Proposed methods that use centralized MPI with pointers also rely on ‘behind the scene’ identifiers**
**Include projects that use Voluntary Patient Identifier (VPI)**
- Cost will be distributed if existing process &  infrastructure are leveraged
- Congress to lift the ban - VPI is patient’s choice
- NCVHS to advise HHS & Congress to act
**Privacy Regulation based on federal legislation is in place **
- Patient Identifier Action is long overdue
**Not a major change; but evolve, grow and improve**

## FOR FUTURE SIG ACTIVITIES

- Soloman I. Appavu
- Director Systems Planning
- John H. Stroger, Jr. Hospital of Cook County & Cook
- County Bureau of Health Services
- 1110 S. Oakley Blvd., Suite 318
- Chicago, IL 60612
- Phone: 312-633-8100
- Soloman277@cs.com