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.
Patient ID Now has brought attention to the need for a national strategy around patient identification that offers both improved patient safety and improved efficiency to healthcare, well as enhanced interoperability. Although patient misidentification has been a problem for decades, the COVID-19 pandemic heightened the harmful effects of the health system’s inability to accurately match patients to their complete health records.
An archaic section of the federal budget has prevented the U.S. Department of Health and Human Services from working with the private sector to develop a nationwide patient identification strategy, but today the House of Representatives, with leadership from Representative Bill Foster (D-IL) and Representative Mike Kelly (R-PA), once again took an important step forward in repealing this ban.
The coalition is now calling on the U.S. Senate to finally join the bipartisan work of the House of Representatives and repeal the ban this year to work towards a health system that prioritizes the safety and privacy of patients.
“The pandemic made clear that now is the time to take action to ensure the health and safety of patients across the US and bolster the accuracy and interoperability of health data,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “Moving the appropriations bill forward without this harmful ban is the first step toward finding a strategy that can lead to better safety and care outcomes.”
Throughout the pandemic the healthcare industry has struggled to resolve this difficult operational issue. Ensuring the correct patient medical history is accurately matched to the patient is critical for future patient care, patients’ long-term access to their complete health record, accurately tracking vaccination status, and monitoring the long-term effects of COVID-19.
“ACS applauds Congress in taking necessary and overdue first steps in working towards the trusted, digital identity of patients so that surgeons can exchange information on their behalf,” said American College of Surgeons’ medical director of quality and health policy Frank Opelka, MD, FACS. “Our patients deserve trusted, shared information as they navigate a complex healthcare system.”
Here is what leaders of other coalition member organizations said about the recent vote:
“Today, because of a narrow interpretation of an outdated appropriations restriction, there is no consistent and accurate way of linking a patient to their electronic health information as they seek care across the health care continuum. This essential but missing functionality would add significantly to providers’ ability to manage care safely, and if it were in place, it would assist in effectively battling the coronavirus. We applaud the House Appropriations Committee for lifting the restriction and urge the Senate Appropriations Committee to do the same,” said Intermountain Healthcare President and Chief Executive Officer Marc Harrison, MD.
“HIMSS applauds the House Appropriations Committee for taking critical steps to eliminate the outdated and harmful ban on a unique patient identifier,” said HIMSS President & CEO Hal Wolf. “We must now focus on advancing a nationwide patient matching and identification strategy that supports patient safety through interoperable digital health information exchange and strengthens patient privacy rights. We urge the Senate to follow the House of Representatives and remove the ban.”
As COVID-19 closes in the on U.S., the need for longitudinal health data and interoperability have never been greater. Providers need access to the full picture of every patient they treat, and epidemiologists need to consolidate data from multiple sources to track the spread of the disease and determine where more aggressive containment strategies need to be employed.
For many organizations already overwhelmed, fragmented systems lead to an infrastructure bottleneck, resulting in degraded data quality, gaps in care coordination, medical errors and burdensome workflows. Lack of comprehensive medical data impairs a provider’s ability to know how many people have the virus, the geographical location of confirmed cases, and the effectiveness of treatment.
Even as capacity restrictions force organizations to work without barriers—via drive-thru screenings, make-shift tents or by way of telehealth—real-time access to data can help streamline care management, whether fast tracking admissions or empowering patients at home through online portals.
Here are just five ways data interoperability plays a pivotal role in addressing the epidemic:
Coordination of Care: COVID-19 provides a sobering reminder of just how dire an integrated, scalable and interoperable healthcare infrastructure is. Coordination among first responders, public health officials, labs, acute and post-acute facilities will be critical to efficiently deal with the explosion of cases. Insurers will also be a key player of the care coordination team as to not slow down or hold up prior authorizations and patient discharges. Access to information about hospitalizations and test results among healthcare participants will be vital for enhanced continuity of care across settings and transitions. Real-time data afforded by interoperability bypasses the need for phone calls and faxes, which create delays and information inaccuracies.
Patient Identification: A complete view of one’s medical history can be a matter of life or death in the face of COVID-19. Bringing disparate medical records together into a cohesive story enables those on the frontlines insight into an individual’s pre-existing medical conditions, medications, allergies, etc. to make the most informed decisions under insurmountable circumstances. Patient demographics and data standardization play a huge role. Accurate patient identification ensures data about an individual is correctly linked, updated and shared, for improved clinical decision-making and enhanced care quality and safety. As health officials look to track and predict the spread of the virus. A complete view of the patient population can only be done with a firm understanding of the patient’s identity, and the key relationships the patient has to their next of kin and to their providers of care.
Budgets and costs regarding IT are expanding more than ever- healthcare providers are increasingly focusing on requirements that demand up to date facilities as well as stability.
This is the conclusion of a survey by the firm Navigant Consulting and also explains a few more insightful details. Health systems are confidently financing in spaces such as improved EHR systems, process automation, better revenue integrity, as well as attaining improvements in revenue cycle via third parties.
This survey was conducted via HFMA (Healthcare Financial Management Association) and its sample included more than 100 CFOs and revenue cycle members from health systems, as well as hospitals.
One of the main takeaways from the survey is that almost two-thirds of the sample stated that they face problems primarily related to EHR systems- either they underutilize their EHR systems, or else they are facing challenges with EHRs like getting better results or else cannot cope with the continuous upgrades. However, even with all these, patient misidentification persists within the healthcare system of the US and is still a top concern for most providers.
Payment concerns like out of pocket payments are also another challenge, according to the respondents- 85% of respondents feel that lack of insurance will be detrimental for the healthcare providers since they rely heavily on insurance payments. However, even in these cases, they face denied claims when patients are misidentified.
To face all these issues altogether, almost 70% of the sample agreed that increasing the budget is necessary to overcome them. However, fifty percent of the respondents stated that they are collaborating with third parties to maintain revenue cycle costs, better patient identification, as well as challenges like denied claims.