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The Need for a Nationwide Patient Matching Strategy
Session #400, March 6, 2017
Dr. John Halamka, Chief Information Officer, Beth Israel Deaconess Medical Center
Ben Moscovitch, Manager, Health Information Technology, The Pew Charitable
Trusts
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John Halamka, MD
Ben Moscovitch
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Agenda• Causes and implications of inadequate patient matching
• Methods used for matching domestically
• Various options to advance patient matching
• A nationwide approach attempted abroad
• Moderated discussion
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Learning Objectives• Differentiate between the various ways hospitals currently match
patients, and why they are insufficient
• Evaluate the existing alternatives to matching patients and identify the strengths and weaknesses of each
• Explain the need for a single, nationwide strategy for patient matching and how it could promote patient safety
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Matching: Current RatesPatient Matching: The ability to link an individual with his or her medical records, and connect different records that refer to the same person
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Matching: Implications
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Matching: Common Problems
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What Does a Patient Index Do?
When looking at two records, it calculates an “Agreement Weight” for
each field, based on how similar they are (e.g. Is the Date of Birth the
same or close to the same?)
Then it adds all of those “weights” together to form the overall similarity
for that pair
Based on the configuration of the system, it either decides that weight
represents the same patient, different patients or puts the pair on a
worklist for manual review
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Weight Example
Total Calculated Weight for this pair = 26.5
This is compared to the Thresholds to determine if the pair is automatically linked.
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Thresholds
Autolink
Threshold
Links
?
Validate
Threshold
Validate
Review
Threshold
Non-Link
?
Review
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Potential Opportunities1. Have unique patient identifier that could be used for matching
a. Perennially discussed in healthcare
b. At this time, would need to be private-sector led
2. Patient-focused approach
3. Enhanced demographic standards
a. Agreement on data elements
b. Use of novel data elements
4. Use of third party data
a. Questions on costs; pediatric populations
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Nationwide Strategy Needed
Convened experts on a nationwide strategy
• Matching occurs cross-organizations with different policies
• Many different technologies in play
Some key characteristics discussed:
• Government can’t be the driver—should be private-sector led
• Trusted organization could help coordinate & identify standards
• Standards-based
• Flexibility for different technologies and capabilities
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The Gates Foundation South Africa Project
The 90/90/90 national policy goal
• 90% of patients with HIV know they are HIV positive
• 90% of patients who know they are positive are treated with anti-virals
• 90% of patients who are treated have laboratory evidence of viral
suppression
The challenge
• Low sensitivity and positive predictive value from demographic matching
approaches
• A highly mobile population
• Unstable infrastructure - electrical power, bandwidth, compute/storage
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The Approach • Biometric matching using low cost mobile “kits”
• A decentralized data storage infrastructure leveraging blockchain for data integrity
• A medical wallet that runs on basic phones
12/18/201715
Biometric linking kit … configured to have an iris biometric device, a touchscreen, a label printer and a bar code scanner…
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Patient
Poly-unique patient code, AA code, clinical record scan
Poly-unique patient code on clinical patient folder
Poly-unique patient code on ticket given to patient at reception as they move from station to station
GUI on small screen for clerk and clinician to scan patient, QR codes or bar codes during an “event”, and to look at prior linked “events”
Linking the patient within and between clinics and to clinical and laboratory records, and enabling independent and incremental
deployment at clinics over time … Linking events at a clinic (e.g. arrival, phlebotomy, doctor assessment) for a patient over time .…
Bar code and Document scanner
BiometricDevices
Label Printer
Event not yet linked
Events linked
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Metrics for Success• Matching sensitivity and positive predictive value
• Provider satisfaction (90/90/90 data easily available)
• Patient satisfaction (excess testing avoided)
• Reduction in redundant/unnecessary care
• Stability/reliability/security of data exchange
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Questions
John Halamka, MD
Chief Information Officer
Beth Israel Deaconess Medical Center
Ben Moscovitch
Manager, Health Information Technology
The Pew Charitable Trusts
t: @benmoscovitch