Bill Spooner: National patient-matching efforts need some work

According to former Sharp HealthCare CIO Bill Spooner, patient matching efforts should be more about improving safety than achieving perfection.

To that end, Spooner (pictured), who recently retired after 18 years leading the San Diego-based health system's IT initiatives--and 35 years overall at Sharp--told FierceHealthIT in an exclusive interview that the government shouldn't be so quick to dismiss use of a universal identifier.

"An absolute identifier would result in a more accurate record, which should improve patient safety," Spooner said at CHIME's CIO Forum in Orlando, Fla., in February. "It's kind of hard to overlook that."

In part 1 of his discussion with FierceHealthIT, Spooner talked about the recently released report from the Office of the National Coordinator for Health IT on patient matching, as well as Sharp's "trial-and-error" path to being a national leader on the patient-matching front.

FierceHealthIT: What did you think of ONC's recommendations for improving patient matching?

Bill Spooner: It's a good start. Anything is better than not very much. When I say good start, I specifically am talking about the suggestion that we define the elements uniformly so that we ask EMR systems to all specify first name, last name, middle name, etc., all in the same manner, things like that. That makes sense. If that helps to avoid some of the obvious causes of mismatching, that's good.

On the other hand, I feel that there's a lot more work to be done. There have been suggestions about maybe adding a specific element as another matching criteria, like birth date, and questions about if that would help. But people can lie about their age. The proposed improvements to matching really need to be tested.

FierceHealthIT: ONC's findings indicated that certification criteria should not be created for patient matching algorithms or require organizations to utilize a specific type of algorithm. Do you agree?

Spooner: We don't know that a different algorithm will be better or worse than the one we have. Without testing, we don't know. Suppose that I use a government-mandated algorithm that causes mismatches which results in inpatient harm--who's got the liability for that harm? It would be the provider, but based upon a government requirement.

Some of us are in favor of a uniform number--an absolute identifier. It's a real quandary because we recognize the concerns about privacy. We all recognize the very visible government mistakes: they can't program HealthCare.gov competently; the NSA snoops on everybody; the government has as many breaches as anyone else. So would you trust using a number?

But if a person had an opportunity to accept a number--say "I opt in for a voluntary identifier"--and if then the systems were uniformly able to contain that identifier for those that opted in, that might make a huge leap, though we would still have risks around those who don't want it. It would be interesting to see in a few years what the impact would be.

FierceHealthIT: Talk more about what Sharp has been able to accomplish on the patient-matching front.  

Spooner: We've been doing this for more than 20 years. In the late 1980s, we decided in my organization--and we were an organization growing through mergers of hospitals and medical groups and other related providers--that it should be an obvious capability that when any patient walked into any institution with our name on it, we should be able to pull up their record. That should be a no brainer.

Part of our selection process in looking for a new system was that it had to be able to handle a master patient index. As we implemented it at hospitals, we had to figure out how to match them. Fortunately, we tested them, but we--by trial and error--identified the matching criteria that worked best for us, comparing false-positives/false-negatives. I don't remember how we arrived at the criteria, and I'm sure we tweaked them over time, but developed that well for our organization.

After one of our mergers, we realized that we had a few false positives--overlaps--and realized that we basically had merged [information] incorrectly. A physician in those cases discovered it. That caused us to realize that we had to get better at it. We had to get better at the detective process to identify those. So we more formalized the merging process, we put in [voluntary] palm-vein scanners in our registration areas. That was really good identification at the point of entry for our existing patients.

FierceHealthIT: How can other organizations improve their patient-matching efforts?

Spooner: There's the budget dollars and then there's the determination to do something about it. I think that most organizations know that they have to as they adopt electronic records. It's just that some have been faster to the mark than others.

We were fortunate to an extent because we had such a heavy capitated business that it was do or die for us.

When we first implemented new computer systems in 1991, we thought we had done a wonderful job in matching. Then, after we sent around 15,000 incorrect patient bills, it was because our matching criteria had been too tight. We improved because of the market we were in; the business we were in pushed us along. It wasn't because we were more visionary. We screwed up.

I hope that our experiences help to guide other organizations in their efforts.

Editor's Note: This interview has been condensed for clarity and content.

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