Health Information Exchanges are no longer new and shiny so it’s easy for us to forget the importance of their role in delivering patient care. So, today let’s reflect a little on the concept of the HIE and its foundational role in interoperability, particularly around patient identity.
In the days of yore nobody exchanged information. Charts stayed in the hospital, patient’s came and went, and many medical mistakes were made due to a lack of information.
A slow change began with the invention of the Problem Oriented Medical Record by Larry Weed in the 60’s. In the 70’s these ideas became the first real EMR at the Regenstreif Institute. Over the next twenty five years the technology languished. Finally, in 1990 the Institute of Medicine wrote a seminal paper recommending that each physician use computers in their practices. And so, slowly, the modern EMR was born. In 2004, President Bush stood firmly behind the initiative in his State of the Union Speech, saying “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
The first HIE I am aware of was the Santa Barbara County Care Data Exchange. Funded in 1999 by the California Healthcare Foundation (CHCF), this RHIO was the first truly regional initiative for securely sharing clinical data.
What’s not surprising about this RHIO’s experience is that, according to a root cause analysis published by CHCF, one of the first issues they ran into was – you’ve got it – patient identity.
It’s a difficult problem that is often understated. Case in point – I read a piece today by Vera Gruessner titled, ‘Three Recent Major Health Information Exchange Developments” where the author makes the following statement.
A more robust patient data matching strategy across the country will bring about greater interoperability among HIE systems. Incorporating a standardized patient data set will ensure that patient records are linked to each other in the HIE and physicians are able to access a full medical history before determining the most appropriate treatment for patients. Adopting a uniform patient matching data set is likely to reduce medical errors and improve the quality of health information.
Ok. So if I have an HIE in New York, and an HIE in Nevada will a uniform patient data set ensure the records are linked together correctly? Is there a patient data matching strategy that can help? Yes, but it is by no means automated, thanks to complex and multifaceted issues such as consent and HIPAA.
In New York, the patient matching service understands the regulatory landscape. If I present data fields from two potentially matching patients to the service, it will either tell me they match or they don’t. It most emphatically will NOT tell me about other patients who *might* match – that would violate HIPAA as I have no need to know who the other (potentially matching) patients might be.
When you start to mix issues of consent into the equation things get really, really, confusing.
So, is this interoperability focus going to fix the patient identity problem? Of course not. When every system in the world suddenly starts talk to every other system we’ll just have more patient identity matching problems. I don’t imagine we’ll see a national identity any time soon ….
And, somewhere, somebody, at an HIE somewhere (or an equivalent) will be scrubbing the data and making things nice.