Patient identification: where systems integration and interoperability begins

1. Patient identification: where systems integration and interoperability begins John Follin Damian O’Gara i+ IT Ltd

2. Contents • Background – i+ IT Ltd • Maturity Models (MM) • Patient Identification MM • Our Work at Mid-Yorks • Summary • Q & A

3. i+ IT Ltd • Four directors met on NPfIT Spine project at BT. • Inspired by aims of the National Programme • Formed i+ IT to help achieve one of those key aims: “One Patient, one identifier, one record – available to the entire care team at the time and place of need”

4. Sharing Patient Data Pre-requisites: • Physically connect systems holding patient data – more later • Accurately identify the Patient • At System level • At Trust Level • At NHS level “Is John Smith with data in System A really the same John Smith who has data in System B?”

5. A complex problem • Patient Identification is not a simple issue • NHS Numbers • People do not know or carry them • Many (legacy) systems do not store or use them • A continuum of differing practices within and between Trusts (e.g. Mid Yorks, Heart of Birmingham) • These experiences suggested a Maturity Model (MM) approach to progress the problem • Hence a Patient Identification MM or PIMM

6. Maturity Models (MMs) • Started with Capability Maturity Model – late 1980’s, early 1990s • Applied to many other contexts since • Continuum from some starting point to an idealised goal end state. • Way of breaking down complex problems into manageable solution steps • In terms of costs • In terms of organisational change • In terms of process

7. Advantages of MMs • A place to start working to improve a process or system. • Gain the benefit of a wider community’s prior experiences. • Provides a common language and a shared vision. • Provides a framework for prioritising actions to yield the best value return on investment. • Is a way to define what improvement means for an organisation.

8. The Patient Identification MM (PIMM) • 6 levels (for now) • Initial state – each system creates a new record for each encounter • Idealised end state: “One Patient, One Identifier, universally available to all health providers” • Application of it advocates decision support systems over decision making systems

9. Characterised by insignificant number of duplicates and confusions, identity synchronised to national register using fully compliant PAS. Level 6 Optimised Characterised by comprehensive monitoring and reporting of duplicate and confusion cases. Level 5 Managed Characterised by continuous, pro-active improvement in identification data quality. Level 4 Pro-active Characterised by robust workflows with Patient verification against national systems part of “business as usual”. Level 3 National Characterised by institutionalised implementation of local Patient identification Processes and Policies. Level 2 Local Characterised by poorly controlled patient identity, proliferation of duplicates and confusions. Reactive processes to reconcile. Level 1 Initial

10. Our work at Mid Yorkshire NHS Trust • Short Study and Report into Duplicate Patient Records • PIMM level is between 1 and 2 • Duplicates are created on the PAS for a number of reasons, including the following Search capabilities on the current PAS are very limited. • Data is not synchronised with the national identity register (PDS) and so may hold out of date details for the patient (name, address etc.) • Correctly identifying a patient’s id can be time consuming in more difficult cases and some areas may not be able to do this exhaustively. • There is significant transfer of data verbally, written and by memory (copying from screen to screen) when performing patient registrations.

11. Recommendations being Implemented to achieve PIMM Level 4 • Phase 1 - • Provide a simple workflow system for new registrations • Institutionalise the use of the SCRa • Phase 2 – Improve Search Capability • Provide a local Intelligent Search Capability • Provide automated trace to PDS

12. Current Status • Completing implementation of Data Quality Workflow Application. • This includes a new Ensemble based process to route new registrations to the Workflow Application • Workflow Application being developed on Intersystems’ Ensemble Technology • Starting to look at the next phase and considering technology platform for local algorithmic tracing (Mirth Match, Intersystems, etc)

13. Summary • Patient Identification ‘hard but do-able’ • Solutions may never be perfect • No reason to give up: all improvements save money, improve patient care • Advocate Decision Support, not Decision Making, systems • An ‘MM’ approach seems useful (to us) • Has helped formulate a road map at Mid Yorks • If you choose to use the PIMM, please tell us how you get on

14. Any Questions? ?