Not all hospitals have been able to make the kind of investment Geisinger has. "Right now, the current matching strategy [for] when somebody's not within the system is using their other identifiers: their name, their date of birth, their Social Security number, a variety of things," says Bala Hota, CIO and CMIO of Chicago-based Cook County Health and Hospitals System, with a 464-bed main hospital and a variety of clinics. "But what do you do if the patient doesn't have a Social Security number? Or if there's some problem with the data that you receive? In a public hospital system, that's often the case, and so then you're forced to do some other matching on the data elements."
While Cook County H&HS has "really good matching" about 70% of the time, he says that still leaves the other 30%. "You have to have manual matching. You have to have an inbox almost for somebody to do a match. There's a lot of work there," Hota says.
So he is turning to Cerner Corp., which supplies Cook County H&HS' EHR. "We've looked primarily at the system that's integrated with the Cerner electronic record, and they have this self-registration kiosk that they offer," Hota says. "The advantage is it's fully integrated into our existing electronic record and so we won't have to worry about designing and implementing a project to integrate some external system."
Payer-assembled data forms the cornerstone of the patient ID efforts of Salem Health, a two-hospital system with more than 450 acute care beds based in Oregon's Willamette Valley.
The insurance industry has previously struggled with the question "Was the Mary Smith who has BlueCross the same Mary Smith that has Aetna Medicare?" says Cort Garrison, MD, MBA, CIO of Salem Health. "They have some matching algorithms, as well as somewhat of a common database that we think covers about 70% to 80% of our population."
Salem Health plans to leverage this insurance industry work to bring up a communitywide central repository as part of its coordinated care organization, the state of Oregon's equivalent of an accountable care organization.
Since Oregon's 15 CCOs just organized starting August 1, 2012, they are "fairly new structures," and implementation of the patient ID system is depending on state Medicaid funding that is still pending, Garrison says. But an "agnostic" patient ID system must be built, because "no one EMR is a single source of truth in this community. Our Epic system has the inpatient and some of the outpatient stuff," but other record systems hold other patient data.
"We have basically three disparate EMRs that are prevalent in our community that we need to integrate for transformation purposes." Vendor-supplied EMPI technology alone is insufficient, Garrison says. "We could get there by using that technology alone, but I think we can get there faster by using a different source," he says.