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By Tom Groenfeldt
Social Security numbers should be a great way to identify patients in hospitals, except that not everybody has one. And if you are talking about pediatrics, many children are identified by a parent’s Social Security number when they are born and for years after. How about names? They are certainly distinctive. Some of the time. Think of Maria Gonzalez in Los Angeles or Patrick O’Brian in Boston.
It’s not such a big deal if you are taking attendance or handing out raffle tickets, but it does matter if O’Brian has just arrived in the emergency room strapped to a gurney and physicians have to act fast.
Hartford Hospital in Connecticut is using Enterprise Master Patient Index (EMPI) software from NextGate to identify patients across different networks and systems.
Stephan O'Neil, CIO and vice president of information services at Hartford Hospital, said he recognized the need for better patient identification systems after working at St. Claire’s in New Jersey. The medical center ran four hospitals with financial and clinical applications, physician practices, home healthcare and medical laboratories, all with their own systems.
“We needed to know information about patients as they moved between various care centers and systems.” Nothing on the market could do that well, so he turned to SeeBeyond, a data integration specialist later acquired by Sun. The technology moved to open source and then eventually spun out into NextGate. The developers created the first master patient list using a variety of identifiers, not all of which are intuitive choices. NextGate uses cell phone numbers as part of its identifier. People usually have their first phone by the age of 15 and keep the number for years. NextGate also assigns weights to patient names, depending on the local population. A Maria Gonzalez wouldn’t carry the same importance as a unique identifier in Los Angeles as it would in Portland, Maine.
Andy Aroditis, CEO of NextGate, said the software will achieve 85 percent to 90 percent certainty of a patient’s identity. If an identification falls into a gray area, people check it manually.
“It is absolutely essential we identify people correctly as they appear in these different care settings,” explained O’Neil. While Hartford Hospital is a national leader in electronic records for patients, hospitals have only the information generated by a patient’s visits to its facilities. In most cases, the bulk of an individual’s medical record is in a paper file at her physician’s office. That’s why hospitals routinely collect a lot of information at admission and administer tests and X-rays -- because they can’t access information unless it is in their own system. The result is expensive duplication of tests, and in the case of X-rays, more exposure to radiation.
In Connecticut about 10 percent of physicians have moved to electronic patient records, although that number is expected to rise quickly with the significant federal funding which has recently been allocated to make patient information electronic.
“I hope to see it at 80 percent in four or five years,” said O’Neil. Then a Health Information Exchange (HIE) to move patient data between care providers, therapists, pharmacies and laboratories becomes really useful. Many physicians don’t want to go through the process of automating their operations, which can require a page by page review of records to see which should be scanned for retention and which can be discarded. Federal funding should help.
The acceptance among physicians is often related to their background and age, but O’Neil notices progress among physicians at Hartford who have seen the hospital and some of their peers move to electronic records.
“They see it is not as bad as they thought it would be; acceptance among our physicians is up from even a year ago.” The ability to share data among healthcare specialists will lead to higher quality care, he added.
“We are linking our specialists with radiologists and private care physicians. Once they have access we see how quickly phone calls and faxes fall away.”
One challenge for national health care records is that systems are developed by vendors without any national standards.
“The Obama administration is pushing interoperable systems and data standards. What they are doing is right on; they are funding the things that are necessary. Now it is up to us to take that money and use it well.”
NextGate’s ability to identify people clearly is also used by Harrod’s, the London department store. The retailer uses the software to cluster family members under one umbrella and identify those under 16, because English law forbids direct marketing to anyone that age. The consolidation of information by family also helps the store reduce duplication of catalog mailings.
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