Presenters Ian Stahl, Initiate Systems

1. PATIENT IDENTIFICATION CROSS-REFERENCING (PIX and PDQ):AS THE STRATEGIC FOUNDATION FOR INTEROPERABILITY Presenters Ian Stahl, Initiate Systems

2. Your Presenter • Ian Stahl, • Director of Product Management,Initiate Systems, Inc. • istahl@initiatesystems.com • (512) 634-5183

3. The healthcare reality • Volume of patient data increasing exponentially • Quality of patient data declining • Fragmented, duplicate and conflicting patient information within and across databases andtouch points • Regulatory and safety issues drivenew requirements ADT Rob Johnson 1000 Main St. Lab Robert Johnson robj@aol.com PACS Bob Johnson (555) 123-4567 Billing Bobby M. Johnson credit card# 5555-55-1234

4. Critical Data Details • Over 30% of all Master Person Index (MPI)records have an invalid or blank value inname (first/last), date of birth or gender • Jumps to over 60% if middle name counted • Over 80% of all confirmed duplicate recordshave a data discrepancy in one or more keypatient identifying fields • i.e., Name, date of birth, SSN/SIN or gender • Nearly 40% of all duplicate records havea discrepancy in the first or last name

5. Interoperability will drive and deliver EHR Identity Identity Real-time Updates Real-timeQuery HL7 API Real-time Query Identity EHR Real-time Query API Identity NCPDP Nightly Update Search Identity XML Flat File SOAP Real-time Updates Identity Identity Hospital 2 Hospital 1 County General Hospital 3 Public Health General Clinics, Labs, Imaging Hospitals (for Inpatients & Outpatients) Pharmacy& Pharmacy Benefits Mgmt. Clinical System Physicians Network Lab Systems Physician Labs & Imaging

6. The Basic Questions • How do I begin to integrate all these solutions? • Use and insist on IHE Profiles – Templates for needed interoperability functions • What do I use to “glue” these solutions together? • HL7 Messages – Healthcare messaging standard already used • What drives access to all the solutions? • The patient – Healthcare is about the patient information • How do I deliver an EHR? • Find the patient – Use IHE Profiles with HL7 Messages to access the patient records and other supporting data

7. Patient Identity Drives Interoperability The Key to Patient Identity is: • Do we know this patient? • Is this the correct patient? • What information do I have about this patient? • Where did this patient information come from? • What “view” do I have of this patient? • What else do I know about this patient?

8. How Does PIX/PDQ Drive Interoperability By answering the questions: • Do we know this patient? • PIX/PDQ Query from client to XRef Manager • Is this the correct patient? • PIX/PDQ Manager must handle, accurately, the matching and linking with tunable probabilistic algorithms • What information do I have about this patient? • PIX/PDQ Manager Response to query • Where did this patient information come from? • Domain based HL7 Messages Identify sources • What “view” do I have of this patient? • Security applied at the application, PIX/PDQ Manager , or both • What else do I know about this patient? • Extending the PIX/PDQ Manager and using other IHE profiles (i.e. XDS)

9. Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234 Trusted system of record 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Interoperability requires accurate patient matching and linking P&C policyholder data Debbie Dozier -Becker 9146 E VIA DEL SOL NETOWN, CA 45883 Local identifier 12/19/61 – 727 Claims and billing data Debbie Becker NULL 5555-55-1234 Local identifier DBECKER1234 Debbie Dozier NEED INFO 5555-55-1234 Local identifier 12345ABCDE Commercial policyholder data Debbie Becker 9146 E VILLA DEL SOL NETOWN, CA 45885 Local identifier HOSPABC98765 Initiate Identity Hub™ software • Derives & standardizes data for efficiency • Finds all potential matches • Use sophisticated probabilistic statistics to compare many attributes & score records • Puts results in 3 buckets – link, don’t link, needs manual review Web self service data Store #3908, Zip = Debbie Becker 9146 VIA DEL SOL 480-473-3486 Local identifier BECKER4804733486

10. Identity Identity Real-time Updates Real-timeQuery Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234 HL7 API Real-time Query Identity Real-time Query API Identity NCPDP 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Nightly Update Search XML Identity Flat File SOAP Real-time Updates Identity Identity PIX/PDQ Managers change the healthcare ecosystem Hospital 2 Hospital 1 County General Hospital 3 Public Health General Trusted system of record Clinics, Labs, Imaging Hospitals (for Inpatients & Outpatients) Pharmacy& Pharmacy Benefits Mgmt. Clinical System Physicians Network Lab Systems Physician Labs & Imaging

11. Process Registration Scheduling Billing The invocation of the necessary services to provide the most accurate information to the right place at the right time Purchasing Care delivery Diagnosis Treatment Communications Research Interoperability defined People Public Health Pharmacy RHIO Payor Provider PBM Supplier Radiology Physician Etc. Patient Privacy, Security, Standards, Regulatory Compliance Data Patient 3rd party/ Ref. data ERP Clinical Financial Etc. DI Provider Rx Resource Formulary Research

12. Data Services Reference architecture Medicalmgt Radiologymgt Customer portal Medicationmgt On rampto RHIO Labmgt Service Sticky applications Business Business Logic Application Services Solution Consulting Standards Core Business Services Integration Initiate Identity Services Hosting Infrastructure Security Services Data Services Messaging Services and Source Adapters 3rd party EMPI HIS Clinical Financial Provider

13. How to get started • Start with choosing a solution that supports the IHE PIX/PDQ Manager functionality • Choose vendors who have products that support the PIX/PDQ client to call the IHE PIX/PDQ Manager • Feed the IHE PIX/PDQ Manager patient identifying information

14. IHE Web site: www.IHE .net • Frequently Asked Questions • Integration Profiles in Technical Frameworks: • Cardiology • IT Infrastructure • Laboratory • Patient Care Coordination • Radiology • Connectathon Results • Vendor Products Integration Statements • Participation in Committees & Connectathons

15. Questions? • Ian Stahl, Director, Product Management • istahl@initiatesystems.com • Bill Klaver, Healthcare Solutions Architect • bklaver@initiatesystems.com www.initiatesystems.com