Slaying the Duplication Dragon

I’m fairly certain that just about anyone reading this post is aware of the origin and content of HIPAA, which was signed into law in 1996 to “improve the portability and accountability of health insurance coverage” for employees between jobs. However, one key piece is missing. The original Act included a provision for the creation of a National Patient Identifier (which I covered in my second post).

This may seem a little like the movie “Groundhog Day” where Bill Murray kept living the same day over and over again. I seem to keep coming back to the topic of positive patient identification. I’m certain that there’s a subconscious reason for it.

What jarred me into thinking about this again was a recent Wall Street Journal article, entitled “Tech May Cure Patient ID’s Woe” — if only that was true. Don’t get me wrong, I do believe that there will be a tech component to the solution, but technology alone will not be “the” solution.

The article starts out with the sentence, “Biometric technology is coming to the hospital.” As many of my CIO colleagues already know, biometric technology is not new to hospitals; we’ve been working with biometrics for many years in a variety of areas: patient identification, employee/staff identification, etc. In some of the early pilots, we learned it was very expensive to deploy throughout the enterprise and the technology still needed some work. It’s much better by today’s standards, but it is still not inexpensive.

What caught my attention about the article? This must be getting some traction in the industry for the WSJ to give it a quarter of a page of newsprint. I’m encouraged that a growing number of people are “getting in.”

Why does the Issue Appear to be Growing

I can promise that this is not a new issue. As long as there have been medical records, there have been issues of positive patient identification and duplicate medical records. However, in our zeal to automate the record-keeping of the healthcare landscape (yes, I’m one of the zealots), we’ve enhanced our ability to create errors.

Think about it for a moment; as we automated various functions within a hospital, we did it by implementing the applications with the best functionality for a specific department. We used to call it the “best-of-breed” approach; give the departments the best functionality that they need to accomplish their specific workflows. It took us a few years, but we finally figured out that the best-of-breed approach, while rich in functionality, came with a hidden cost: integration. You had to get the applications to talk to each other, and it is expensive to create and then maintain these integrations. It also provided opportunities to inject a lot of hand-off errors into the processes.

I’m reminded of an old adage, “To error is human, but to really screw it up requires a computer.” This may appear to be a little derogatory, but it illustrates the fact that if a computer creates an error within a process, it will create that same error each time the program/routine runs. It’s only as good as the programmer and/or QA analyst.

According to an AHIMA article (which was referenced in the WSJ piece), the prevalence of duplicate records is between 5 and 10 percent. Some merged organizations have seen duplication rates as high as 20 percent. From my experience in attempting to slay the duplication dragon, these numbers are right on target. However, as I mentioned earlier, this is not a “technology alone” issue; there is also a human component and a process issue that needs to be addressed.

While I was working in Georgia, we kept seeing the number of duplicate medical records rise. We learned it was coming from a remote imaging center where staffing was light and the radiology technologists doing the imaging were also the ones completing the “quick registration” process. Needless to say, the center was very busy and there wasn’t a lot of time allotted to make sure the patient’s records were matched with previous admissions/visits; they just needed the patient in the system so they could enter the order, do the exam, and move to the next patient. I’m sure the same process was repeated multiple times within other facilities. The moral to the story? You need to make sure that your process house is in order — if not, you will be automating a mess, making it worse. IMHO.

Going National

I will give credit to the WSJ for pointing out that being able to positively identify a patient each time that patient has services at a facility is a great first step. But if you look across the national landscape, it’s just one step.

HHS/CMS/ONC are moving us toward national interoperability. What that really means is they want a provider to easily share appropriate information with any other provider. This is something that local/regional/state-wide HIEs have been doing for decades; however, the solutions are typically based upon clinical or regional referral markets. This is where the highest percentage of data sharing takes place. I wish I could say that HIEs had the master solution to positive patient identification, but that would be a stretch, simply due to the fact that their information is only as good as the information that their data sources provide.

However, I see the problem going much deeper than just provider to provide data sharing. Think about the multiple interactions of a patient throughout the care continuum. Patient care doesn’t just occur in a hospital, physician office, or urgent care center; there are multiple other places, such as public health agencies and social services. We’re finally beginning to understand that there’s more to health care than just taking care of someone when they become “unhealthy” or ill.

Facebook and Twitter can do a better job of aggregating data about us than our healthcare industry can. They are, after all, driven by the desire to generate revenue and profit from gathering and using that information. I’ll be bold enough to suggest that maybe healthcare should be as driven in their use of data/information, to keep the population they serve healthy. However, the difference is that we have not figured out how to fund the “keeping the population healthy” part of the equation. (That’s a topic for a future post – or two.)

Back to Patient Identification

Okay, I’ll do my best to put a bow around this thought process.

The business segment of the online world has figured out how to associate various data sources and attribute it to a specific person. Is it 100 percent accurate? Don’t bet on it, but it’s close. Think about how many times you’ve given out your cell phone number. I don’t know about you, but I’ve had the same number for decades; it identifies me better than my address (I’ve had a few of those). Using my cell phone number as a common key data point, you can attribute information from a variety of sources, forming a clear picture of who I am, where I shop, and what I purchase. To be honest, I think they may have learned this from my wife, who seems to know what I pay the moment I make a purchase.

The same can’t be easily done with our healthcare data, thanks to HIPAA and other privacy laws. But the question remains: isn’t it as important for the people helping to keep us healthy, as it is for the folks who are helping us shop online? Several bills have been introduced in both the House and Senate around consumer data privacy. I don’t know if any of them will see the light of day; that conversation is still pending. An RFI was issued some time back asking questions about how HIPAA should be modified or if it should be modified to remove a level of burden from the process of data sharing. (The comment period for that document ended earlier this month.)

I remember why the National Patient Identifier was never created; there were some valid concerns — there were also some unfounded fears. So where do we go from here?

I’m of the opinion that we need a methodology that will provide a much higher accuracy of positive patient identification between sites of care than what we have today. If this doesn’t happen, we will continue to provide more opportunity to inject errors into the patient care process, throughout the care continuum. Do I have a solution? If I did, I’d be out talking to the venture capital companies and working on patent applications.

Here’s my question: is this something that will require the Federal government to implement or is this something that we, the healthcare industry, would be willing to fund through some level of fee, etc? The solution won’t be free or cheap, so it will have to be paid for in one way or another. I’d love to get your thoughts on this.

As I mentioned in my second post, I believe that lack of positive patient identification to be an impediment interoperability. Yes, there are several methods in place today that are doing a good job of identifying patients, but typically, those solutions are still siloed in individual organizations; we need to think bigger.

This piece was originally published on Chuck Christian’s blog, The Irreverent CIO. After spending decades in the CIO role, Christian now serves as VP of Technology & Engagement with the Indiana Health Information Exchange.