Community of Interest for Patient Identifiers AGENDA 1.NHII’s Unique Health Information Identification Requirements - Soloman I. Appavu, SIG Leader 2.Identification Methodology Currently in Use, its Challenges and Solutions - Michelle O’Connor, MPA, RHIA 3.Security Standards that Protect Patient Identifiers and Identification Methods - Lori Reed-Fourquet 4.Accurately Linking Health Information across NHII - John Halamka, MD 5.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 Records4 – 7% 1M TO 5MRecords9-12% >5M Records>14% Evaluation of 300 MPIs (1/3 rd single provider) from 2000 to Facilities out of 300 <2% 98% of providers Exceeded 2% 55% of large facilities >15% 1/4 th >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 Phone: