March 9, 2017 / by Catherine Schulten
Continuity of care is a critical component of a patient-centric care model. In order to be highly functional, this system must include a national patient identity system that works for all individuals and that relies on existing standards and best practices (FICAM, NIST, NSTIC) without the heavy overhead and expense inherent in burdensome federal regulations.
When healthcare networks aren’t communicating with one another how can we expect quality, cost-effective care?
Achieving continuity of care will require not only the collaboration of physicians, but will also require the “de-fragmentizing” of our Healthcare IT systems. Disparate HIT systems, specifically EHRs, need to establish a common foundation upon which they can effectively and accurately communicate PHI/PII between, and within, care networks.
Accurate patient identity proofing coupled with patient matching is essential
Multiple obstacles exist that prevent us from implementing an unhindered patient identity management structure. Prominent challenges include existing low-tech manual patient registration activities which contributes to the creation of dirty data (including keystroke errors, misspellings and the unintended creation of duplicate/overlay records). The presence of dirty data within the record is a patient safety risk, a clinical dis-satisfier, and an administrative nightmare at all care locations – large and small. Another challenge is that each EHR may know the patient by different internal enumerators, including account numbers and medical record numbers – each enumerator varies between facilities and systems. Additionally, a patient’s demographic details vary and aren’t dependable, including name spelling, the use of nick names, outdated vs. current addresses, accidental data transpositions and other errors.
All of these are overriding elements that obstruct the progression of value-based care by causing absolute matching to be a challenge across healthcare facilities and systems. The result is that physicians don’t have access to PHI needed at the point of care due to systems not being able to reliably match the patient’s identity from one system to the next. Even when physicians gain access to MRNs from other locations, there’s no guarantee the referenceable patient information is 100% correct or historically complete.
Reducing fragmentation and increasing data accuracy is the first step
Continuity of care can be achieved through a trusted patient identity system that allows health care organizations to know their patients as a “whole”. Patient identity assurance and interoperability is achieved via multi-factor authentication – the design that confirms the patient’s claimed identity by utilizing at least two different identity factors (something you have, something you know, something you are). Patient tokenization serves as the “1 patient, 1 record” or “1 patient, all correct records” concept. In this environment, the patient-physician relationship is better established due to the access of data via the token, supporting the quality of care provided.
In addition, physician PHI communication, or sharing, has a better platform to run on. Rather than relying on rules-based search and matching of a patient within the local EHR or depending on the HIE to discern matching probabilities, the patient’s token and trusted identity system becomes the deterministic “source of truth” for all locations.
Accurate patient identity is absolutely essential when exchanging patient information. Without high assurance that a patient is, in fact, who they claim to be and the medical records linked to that patient are correct, the patient’s token is no longer reliable. Federal regulations do not mandate strong patient identity proofing today, but other regulating bodies including the ONC, NSTIC, FICAM and others have elaborated on the importance of setting a strong identity foundation
for exchange in the digital evolution.
Rethink what “accurate patient identification” does for continuity of care
Continuity of care is successful upon two key elements; a continuous relationship between health care organizations and their patients, and the seamlessness of care provided across the network. We set out to improve the patient experience, and we want to provide the infrastructure for predictive and thoughtful care to increase positive outcomes of our patients. We must improve identity management in healthcare to make these aspirations an actuality.
For those interested in more information, I encourage you to read the Accurate Patient Identity white paper that describes how patient identity serves as the basis for health information exchange, continuity of care and patient safety.
About the Author
Catherine Schulten is VP of Product Management at LifeMed ID where she is responsible for orchestrating product roadmap initiatives and ensuring that LifeMed ID’s solution offering meets industry user needs. Catherine has over 25 years of health information technology experience addressing industry challenges from revenue cycle, HIPAA transactions, fraud, waste and abuse, and patient identity management. She has served as a WEDI board member and has co-chaired several WEDI workgroups.