The nagging issues around patient matching have plenty of potential solutions. That’s the good news.
The bad news: The healthcare industry still needs to figure out exactly where to focus all of its energy.
That was the central takeaway from a panel of health IT experts, researchers and executives who convened Tuesday morning at an event hosted by The Pew Charitable Trusts. The discussion followed the release of an exhaustive Pew report (PDF), which unpacked some of the key pain points around patient matching and outlined short- and long-term recommendations.
Speakers touched on a range of topics, including the impact of biometrics, smartphones, apps and referential matching strategies. But panelists kept returning to the need for standardization and industry coordination around a distinct set of strategies.
“Standards are like toothbrushes: Everybody has one and they don’t want to use anyone else’s,” said Shaun Grannis, director of the Regenstrief Center for Biomedical Informatics. "So how do we find that commonality is the question. I think that's the nut to crack."
While technical solutions like biometrics offer some promise, standardizing the data that healthcare providers collect is likely to have the broadest impact, according to the Pew report.
That’s backed up by research from the Regenstrief Institute which analyzed four Indiana databases and found that standardizing just two data elements—address and last name—had the biggest impact on match rates.
Grannis said that type of evidence-based research is necessary to help the industry narrow its focus.
“We talk about standards and standardization,” he said. “The fact that standards help is not in question. Which standards we get to is the question.”
According to the Pew report, that level of coordination requires a “single stakeholder-driven trusted organization” to oversee standards adoption. That organization could come from Office of the National Coordinator for Health IT, which plans to appoint a Recognized Coordinating Entity to oversee the implementation of the Trusted Exchange Framework and Common Agreement (TEFCA).
But, the report notes, technology vendors should agree on standardized data elements that can be used for patient matching.
Mark LaRow, the CEO of patient matching company Verato, touted the benefits of referential matching—a technical upgrade from the probabilistic matching that is currently used by vendors in the industry. He advocated for a nationwide “referential-based utility services” that could house the types of standardized data necessary to improve patient matching, comparing the services to a utility.
“It’s almost as if every hospital is using its own electric generator instead of using the power grid,” he said. “There should be a power grid for patient identity that everyone can just plug into and everyone can contribute to and we can all resolve people’s identities for the purposes of healthcare.”
The ability to match patients' records between different healthcare providers is by far the biggest obstacle for health systems, according to Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative which led a focus group of provider organizations.
The majority of the 18 organizations interviewed had intraorganizational matching rates above 90%. But Tripathi said making even small incremental improvements from that point requires “heroic efforts” including more money and people. Some providers had devoted as many as nine people to the task.
And the cost analysis can be difficult to swallow with so many other priorities at play, he added.
“It’s hard to make an additional investment in patient matching without seriously sacrificing another goal you might want to accomplish, like quality,” said Tripathi said.