By Gevik Nalbandian, vice president of software engineering, Lyniate.
As healthcare providers manage market shifts such as value-based care, increased consumer expectations, staffing shortages, changing reimbursement models, and competition from non-traditional healthcare players including Alphabet, Amazon, Apple, and Microsoft — what will it take to compete?
Providers must strengthen the internal IT infrastructure systems to better manage patient relationships. This all begins with easy access to accurate patient data. But with the explosion of data in the healthcare ecosystem, this is no small feat.
Interoperability doesn’t end with integration
Reducing friction in health data exchange requires seamless interoperability among different systems. Interoperability is often viewed as accessing and exchanging data, typically through an integration engine for extracting, composing, standardizing, and passing data between disparate systems. This is a necessary component, but it is not sufficient to achieve a full and accurate picture of your patients and patient populations.
A second component is patient identity management. An identity layer, managed through an enterprise master person index (EMPI), is critical to knowing which patients the data is tied to. In an April 2022 report, Gartner describes EMPIs as “crucial tools for reconciling patient identity and addressing medical record matching challenges needed for high-quality healthcare delivery and health information exchange.”
Accurate patient identification ensures every interaction in which data about an individual is captured — regardless of system or location — is linked correctly for a single, up-to-date view of one’s care. This includes diagnosed medical conditions, lab work, imaging, diagnostic tests, medications, allergies, and family medical history. When a patient’s data is trapped in various systems across the continuum, it can have potentially disastrous downstream clinical, operational, and financial effects.
Gaps or errors in the patient identity management process can have serious consequences for patients. According to a recent survey, nearly 40% of U.S. healthcare providers have incurred an adverse event in last two years as the result of a patient matching issue.
Traditional IT solutions aren’t enough
Health system leaders often rely on their EHR for person identity management. Yet EHRs do not have the same expertise as next-generation EMPI solutions and are not an ideal arbiter of identity data in healthcare ecosystem that increasingly interacts beyond the EHR itself. The average health system has 18 disparate EHR vendors in use across all affiliated providers, according to HIMSS Analytics. Plus, more data exists outside the EHR.
According to a November 2020 Gartner report, “By 2023, 35% of healthcare delivery organizations will have shifted workflows outside the EHR to deliver better digital experiences.”
Four reasons why patient identification should be part of your interoperability strategy
The disjointed nature of IT systems and digital health apps contributes to a proliferation of incomplete and inaccurate patient data that can undermine care quality and safety, reliable reporting and analytics, and operational efficiencies. Here are four strategic areas health system IT leaders should consider strengthening patient identity management.
- Managing populations at scale
Population health management is a high priority goal for most hospitals and health systems, especially those with an interest in the emerging value-based care ecosystem. Improving outcomes while reducing costs is pushing many healthcare organizations to think more proactively about preventing and managing chronic disease, trimming unnecessary utilization, and gaining visibility into patient behaviors outside of the four walls of the hospital.
Population health management gets even more challenging when organizations begin to look at how social determinants of health (SDOH) affect outcomes. Many community organizations do not use electronic health records and may be working with paper-based systems or basic spreadsheets that are not immediately compatible with more sophisticated health IT tools.
A unified patient identity platform will give healthcare leaders the insight they need into clinical and socioeconomic burdens facing the patients so they can take steps to address them.
- Patient attribution for value-based care
Population health management initiatives are often tied to value-based financial models that can support a holistic, proactive approach to patient care. In many of these models, including accountable care organizations (ACOs), providers are responsible for a defined group of patients, known as an attributed population.
Participants can receive financial incentives for meeting cost and quality targets for this group – and may be liable to pay back losses if they fail to hit their goals. Attribution algorithms can be complicated, and providers typically don’t have much say in who ends up under their care. ACOs may become accountable for individuals without strong existing ties to their organization, making it difficult to track and manage their care.
ACO leaders must ensure they are managing patient identities to be certain they know who to serve, how much they are spending, and how to best care for their attributed population so that they meet their goals.
- Quality reporting
Whether or not an organization is participating in an ACO, it is likely to have an array of quality reporting obligations that depend on clean, complete, and trustworthy patient data. Accurate quality reporting must start with having a reliable source of truth.
For large health systems that tend to have higher percentages of duplicate records, the effect of these duplicates can be enough to lose out on financial incentives or produce lower-than-expected quality scores. An EMPI can help providers reconcile all those fragments so they know exactly how many of their John Smiths had positive outcomes and can report on that accordingly so that they are rewarded for the quality of their care.
- Patient experiences
Healthcare organizations simply cannot afford to deliver a poor experience to patients. Patients want seamless capabilities to share their information with the health system instead of the health system controlling the data. With all the options for healthcare services, patients can easily take their business to a provider who has accurate data. A single platform for patient identity management can help alleviate some of the common pain points along the patient journey.
A shared identity management platform across applications and care sites supports a smoother experience while creating trust between patients and providers that the right information about the right individual is being used across the entire health system.
To understand the full picture of patients and their activities, health system leaders need to have not only the ability to access and share data, but also understand the full picture of how patient identity management affects their organization.