Community of Interest for Patient Identifiers

1. 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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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?

11. 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

12. 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