Paul Brian Contino
Corporate Chief Technology Officer
New York City Health & Hospitals Corporation
HIMSS14 Annual Conference & Exhibition, Orlando Florida
CLOSING KEYNOTE: Best Practices - Panel Of end Users
February 23, 2014 3:00-4:15pm
Privacy and Security: Challenges and Opportunities in Healthcare Identity
1. Paul Brian Contino
Corporate Chief Technology Officer
New York City Health & Hospitals Corporation
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
CLOSING KEYNOTE:
Best Practices – Panel of End Users
February 23 2014 3:00-4:15
Privacy and Security: Challenges and
Opportunities in Healthcare Identity
3. New York City Health & Hospitals Corporation
• Largest municipal healthcare organization in the U.S.
• $6.7 billion integrated healthcare delivery system
• Serving 1.4 million New Yorkers every year, including 475,000 uninsured
Facilities:
• 11 acute care hospitals, 4 skilled nursing facilities,
6 large diagnostic and treatment centers
• Health and Home Care (in-home services)
• More than 80 community health clinics
• 420,000 member health plan (MetroPlus)
Care statistics (2012)
• Staffed Beds: 7,554 (4500 acute, 3000 LTC)
• Clinic Visits: 4,876,259 ER Visits: 1,190,413
• Discharges: 221,372 Births: 20,744
.
5. Healthcare : Where Are We Going?
Identity Management
EHR PHR
NHIN
RHIO HIE
eHealth Exchange
HISP
HIO
Direct
ACO
PCMH
Health
Home
MU 1- 2
Circa 2009 2014
Healthcare
Exchanges
Patient
Portals
Blue Button
6. Islands of Information
$2.5 Trillion Dollars
2009 U.S Healthcare Expenditure
EMR 1
EMR 2
EMR 3
EMR 4
$3.1 Trillion Dollars
2014 U.S Healthcare Expenditure (Est)
HIE 1
HIE 2
HIE 3
HIE 4
7. Importance of Patient Identity
Is the patient in front of us who they say?
• Patient safety & appropriate medical care
• Avoid potential medical errors
Linking patient to existing medical records
• Continuity of Care
• Complete and accurate clinical data to our providers
Medical Billing and Claims Processing
• Reduce Medical Identity Theft
• Reduce Fraud and Abuse
Data Sharing with our Partners
• RHIOs, Medical/Health Home, ACO
.
9. The Challenge of Patient Identification
The Demographic Profile
A very limited set of information is
used to identify patients
• Last Name
• First Name
• Date of Birth
• Address
• Full or Partial SSN
(often prohibited)
.
10. Patient
Demographic
Changes
Changing Demographics of Patients
Number of Marriages each
year
Number of Divorces each year
Number of job changes
over the lifetime of an
average worker
Number of US citizens that
moved between 2012 and
2013
(11.7% of population)
12. Healthcare Utilization
Number of different
doctors the average
patient will see in their
lifetime
Healthcare Billing and Payment
transactions each year
ER Visits per year
Physician
Office visits per
year
13. The Longitudinal Patient Record
High School College
Post
Grad
Professional Retirement
Alejandra Ortiz
DOB: 02/23/1949
540 W 2nd Ave
San Bernardino, CA
92410
Family Home
✚
Alejandra Ortiz
DOB: 02/23/1949
3231 Walnut St.
Philadelphia, PA
19104
U. Penn
Alejandra Ortiz
DOB: 02/23/1949
602 West 139th St.
New York, NY
10031
Columbia U.
✚
Alejandra Ortiz
DOB: 02/23/1949
5041 East Vista St.
Long Beach, CA
90803
Family Home
Alexa Thomas
DOB: 02/23/1949
3927 Glenwood St.
Little Neck, NY
11363
✚✚
Alexa Ortiz
DOB: 02/23/1949
1018 Paper Mill Ct
NW Washington,DC
20007
Washington Post
Alexa Ortiz
DOB: 02/23/1949
88 Bleecker St.
New York, NY
10012
New York Times
Alexa Ortiz-Thomas
DOB: 02/23/1949
565 Broadway #5P
New York, NY
10012
Marriage
2 Kids, 1 Dog
New Home
Alexa & John Thomas
2882 Banyan
Boulevard Circle Nw
Boca Raton, FL
33431
Snow Birds
✚
= Unique Physicians
✚ = Emergency Visits
21 Physicians
5 Different States
4 Name Variations
14. The Challenge of Matching Patient Records
Name: Alejandra Ortiz Alexa Thomas
Address: 540 W 2nd Ave 3927 Glenwood St.
San Bernardino, CA Little Neck, NY
92410 11363
DOB: 02/23/1949 02/23/1949
Age: 65 65
Gender: F F
Tel: (909) 883-3386 (917) 245-6565
SSN4: 8696 8669
Are these the same individual?
YES – But Patient Records are
Continually Developing Collections of Changeable
Data
15. National Patient Matching Initiative
December 16, 2013 - ONC Stakeholder meeting to address patient identification and matching.
Patient
Registration
Medical
Record
Payor
PBMAncillary
Systems
(Lab, Rad)
RHIO
HIE
RHIO - RHIO
Nation eHealth Exchange
Cascading Error
“We don’t have an algorithm issue,
we have a data quality issue.”
- Dr Scott Schumacher, chief scientist for MDM at IBM
16. Major Transformation of Healthcare
Rapid Adoption of Electronic Health Records
• 44% (2009) to 73% (2012) have electronic records
Health Information Exchanges (HIE)
• Over 280 across the US with more than 50% of hospitals
participating in HIE organizations, Meaningful Use
New Delivery and Payment Models
Health and Medical Homes (HMH, PCMH)
• Managing patients across continuum of care and
reimbursement based on outcomes (volume to value)
Accountable Care Organizations (ACOs) –
• Over 370 ACOs across the US, 150 more in development
Retail Clinics –
• CVS, Walgreens & Target operate 70% of retail clinics in US.
Virtual Care – Remote Patient Monitoring, eVisits, Telemedicine
.
17. The Engaged and Empowered Patients
• Embracing New Technologies
• Educated consumer of healthcare services
• Patients are making use of retail clinics and urgent care centers
(convenience and lower costs)
• mHealth (Mobile Health and Wellness applications) are
exploding
• Patient Self Monitoring (wearable sensor technology)
• Patients have the ability to stream continuous health data on
dozens of physiological measures and vital signs
(blood pressure, weight, pulse oximetry)
• Social Networks
Challenge : Connecting the Dots
18. Plenty of Technology in Place
Identity Assurance
Bar Codes
ID Cards Smart Cards Biometrics
Sensors
Point of Care Longitudinal Record
19. Patient identification is foundational for the
Interoperability of Electronic Health Records
and for Health Information Exchange
• Go-forward strategy: Patient Identification not Matching
• Policy has hampered progress on crucial research and
development (lost time and funding)
• Put patients at the center of this process
• Patient safety and satisfaction can be greatly enhanced
• Universal Patient Identifier
20. Questions?
Paul Brian Contino
Corporate Chief Technology Officer
Enterprise Information Technology Services
NYC Health and Hospitals Corporation (HHC)
160 Water Street, Office 1312
New York, NY 10038
Tel: 646-458-3888
Fax: 212-788-3446
Cell: 917-279-4760
paul.contino@nychhc.org
Notas do Editor
Ortiz 94th most common to 14th with Thomas
Patient records are continually developing collections of changeable data
Continuing de facto endorsement of statistical matching as the only practicable approach to linking patients to their electronic health records will inhibit the effective development of the national health information network.
http://www.himss.org/files/HIMSSorg/policy/d/2012_Ask1_PatientDataMatchingStrategy.pdf
Enterprise Master Patient Indexes (EMPI) algorithms are at best 90-95% accurate.4 But most important factor is the quality of the data.
Continuing de facto endorsement of statistical matching as the only practicable approach to linking patients to their electronic health records will inhibit the effective development of the national health information network.
http://www.himss.org/files/HIMSSorg/policy/d/2012_Ask1_PatientDataMatchingStrategy.pdf