San Diego Health Connect leverages identity validation to improve patient matching

California health information exchange now sees 98 percent matching rate after upgrading the technology used to manage its index.
By Bill Siwicki
09:40 AM
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San Diego Health Connect health information exchange said it has turned its performance around using identity validation technology.

After facing an unacceptable 70 percent patient matching rate, the San Diego Health Connect health information exchange said it has turned its performance around using identity validation technology to better match patients and in the process clean up its master patient index.

Its current patient matching rate is 98 percent.

"To a certain degree, we caused the problem ourselves," said Dan Chavez, executive director of San Diego Health Connect. "We use very strict matching criteria. Not every HIE uses the strict matching criteria we do. We require a 100 percent match on six variables to automatically match patients. Other HIEs make the governance decision not to match on such strict criteria. If you loosen the rules in probabilistic and deterministic matching, you can have a higher rate. We want the machine to do as much as possible, but we don’t make it easy because we want the faith and trust that what comes out of the HIE is 100 percent correct."

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At the 70 percent matching level, San Diego Health Connect had a backlog of requests that had to be manually reviewed. For example, Dan Chavez and Daniel Chavez and Daniel J. Chavez could all be the same person, with different records at different facilities in the San Diego area. Further, when consumers get married or divorced and change names, multiple different records may exist.

"There are more than a few Chavez's in San Diego, as you might expect, so my name might go into the exception queue — and I’ve received care at Sharp and Scripps, and maybe my records do not match," he said. "Prior to using Verato, someone from the Sharp medical records department and someone from the Scripps medical records department would have to get together through an e-mail or phone call. If I had additionally been to UCSD, or if someone fat-fingered my Social Security number, the exception would pop up yet again for me, and UCSD would have to get online with Sharps and Scripps. So you see the magnitude of the problem."

The exceptions queue grew so large and the backlog so long that medical records departments in the community said this HIE thing was killing them.

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Verato's Carbon is a cloud-based identity data management system, what the company claims to be the most complete and accurate database of U.S. identities.

"We source billions of records including credit agency and telecommunications provider data, along with government and legal data; and we use proprietary technology to produce our view of individual identities," said Joaquim Neto, senior solutions architect at Verato.

San Diego Health Connect, for instance, automatically ran its exception queue against the Carbon database and quickly matched 80 percent of the exceptions to their correct records, Chavez said.

"Then, with a little bit of examination, we could much more easily deal with the additional 20 percent — associating pediatric patients with parent addresses," Chavez cited as an example. "One of the challenges of patient ID in pediatrics is naming conventions. With the interactions with Carbon, we then could go back to the community and say, 'We all are doing some things incorrectly.' It gave us some guidelines in community-wide naming conventions, so we could go back to participants in the HIE and say, 'If it’s a hyphenated last name, let's place the second name in this field and the first name in that field.'"

Improving the patient matching rate earned San Diego Health Connect a higher degree of confidence in the information coming out of the health information exchange among healthcare organizations in San Diego and Imperial County, Chavez said.

"People know if the HIE is delivering information for Dan Chavez that there is a 98 percent-plus chance that we in fact have the right Dan Chavez," he said. "That confidence was not there before."

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The HIE declined to share the cost of using the Carbon system from Verato, but the vendor said the ticket could be between $250,000 to $500,000 a year for an organization the size of San Diego Health Connect.

"The soft return on investment is the confidence in the HIE as we deal with the medical records in the entire community of 3.2 million people; these providers know when they get patient information from SDHC, it is correct," Chavez said. "The hard ROI comes in no need for medical records departments to call up anyone to check exceptions. They do not have to challenge the data or make 3-5 phone calls to reconcile. Those phone calls at a minimum of 5 minutes a head are expensive."

Twitter: @SiwickiHealthIT