October 2017

Thought Leader Q&A: New Jersey Partnership Set to Curtail Patient Mix-Ups
By Lee DeOrio
For The Record
Vol. 29 No. 10 P. 26

For years, the health care industry has struggled with creating a formula to ensure accurate patient identification. Actually, some may say it's not the formula that's lacking but rather the federal wherewithal to get something done. The reasons for the inactivity range from frivolous to complicated, further muddling a situation that poses serious risks to patient safety.

However, help is on the way—at least for New Jersey residents—thanks to a $2.9 million grant from the Office of the National Coordinator for Health Information Technology and the New Jersey Department of Health (NJDOH). The New Jersey Innovation Institute (NJII), in partnership with NJDOH, has created a master person index (MPI) with the capability of linking the health history of every person in the state. The MPI will create a common key linking information stored at a variety of sources, including urgent care facilities, clinics, pharmacies, medical centers, hospitals, and records from the NJDOH.

To get a close-up view of the initiative's plans, For The Record (FTR) spoke with NJDOH Commissioner Cathleen Bennett, JD, and Tomas Gregorio, senior executive director of the NJII Healthcare Delivery Systems iLab. Their answers, like the project itself, were a collaborative effort.

FTR: This seems like a huge undertaking. Please provide some details on how NJII and the NJDOH plan to tackle this assignment.

CB/TG: NJII and the NJDOH are partnering in the creation of the New Jersey Health Information Network (NJHIN), a data exchange platform that will interconnect health care providers across New Jersey. A major challenge in health care is that there are multiple people who have the same name and who could reside in the same community. Creating a unique identifier through the MPI is a way to make sure that we appropriately identify the right person at the right time and in the right location when they are looking to access care.

Our approach is not to mandate use of the NJHIN MPI or other use cases but to demonstrate the value in participating. If organizations participate in and contribute data to the MPI, a "common key" can be assigned that uniquely identifies people and links them across health systems, clinics, pharmacies, physicians, specialists, NJDOH registries, and other data sources based on the demographic and identity information provided. Ensuring that we have quality data will help us improve population health and reduce medical errors, the third leading cause of death in the United States. With the NJDOH, NJII is constantly evaluating new approaches and solutions to address old problems, such as patient identification.

Currently, the MPI is mainly populated with approximately 4.5 million people from the NJDOH Communicable Disease Reporting and Surveillance System, the NJDOH Immunization Information System (NJIIS), and Trusted Data Sharing Organization. To ensure that the NJDOH data used in this project were of the highest quality, in 2013, the NJDOH undertook an initiative to cleanse its data using deduplication.

FTR: What's the target date to be up and running?

CB/TG: The MPI infrastructure is already up and running and contains approximately 6 million records. The NJIIS has already built the connections and integrated into the MPI system, which is planned to go into production in the fourth quarter of 2017. In the last month, the NJHIN platform routed nearly 4,000 [admit-discharge-transfer] notifications to participating providers, indicating that one of their patients was admitted, discharged, or transferred from a participating hospital.

FTR: What technology is involved?

CB/TG: There are numerous technologies involved. At the core is a next-generation MPI that leverages inversed indexes that allow for dynamic patient match scoring. This MPI infrastructure also updates personal information and queries in real time, which is a substantial advantage over other legacy systems that update only in "batches" or during scheduled time periods. Augmenting demographic data with commercially available verification data is being explored and will enhance our matching rates over time.

FTR: From what health care organizations will you be pulling data?

CB/TG: Initially, data will come from several of the state's health registries and hospitals, or private health systems that participated in our pilot program that ran from July 2015 through July 2017. However, we will be rapidly onboarding health information exchange organizations and several large hospitals and health systems over the coming months.

FTR: Please describe the process of gaining the cooperation of other health care organizations to share data.

CB/TG: As state, federal, and private payers continue to drive a shift toward value-based care, health care organizations are recognizing the increased importance of data sharing as a way to improve quality and to better comply with regulatory mandates and private payer reimbursements. As a public health initiative of the NJDOH, the NJHIN enables and encourages data sharing on a statewide basis and will eventually extend to interstate (across different states) sharing.

FTR: What's been the reaction of health care organizations when you tell them about this effort?

CB/TG: They are very supportive and excited about being able to identify individuals across the health care continuum as well as participate in our MPI and other use cases. Participating allows them to improve the quality of care delivery by reducing gaps in care and medical errors, avoiding regulatory penalties, and receiving the most equitable reimbursements possible. All providers understand and appreciate that problems identifying patients have long been a barrier to health information interoperability, increase operational costs for providers, and, most importantly, can lead to medical errors.

FTR: If certain organizations aren't participating, does that minimize the effort's impact?

CB/TG: We want every health care stakeholder in New Jersey to take part and are hopeful that a majority of health care organizations will chose to participate over the next year. As the state makes additional health registries available through the NJHIN, there will be ever-increasing incentives for health care providers and organizations to participate.

FTR: Was patient permission necessary? Were there any legal hurdles?

CB/TG: Establishing the foundational legal work allowing for statewide data sharing through the NJHIN was a key challenge. The NJDOH and NJII worked tirelessly to develop a legal framework that potential participants would benefit from and that respected their privacy in appropriate ways. Every patient signs consent or opts out when receiving care at participating providers, hospitals, or [health information exchanges]. Under HIPAA regulations, NJII, as a business associate and manager for the NJHIN, can share published data for our use cases.

FTR: How will the initiative affect HIM departments?

CB/TG: The NJHIN and MPI will be very beneficial to health information departments, as they will be better able to correctly identify, correct, and update patient data in their internal systems.

FTR: How are the records being secured?

CB/TG: The MPI is housed on a private network accessible only to those participating with the NJHIN. All the data are transmitted securely through encrypted connections.

FTR: There's been talk for years about implementing a national patient identifier. Do you see your efforts as sort of a test case?

CB/TG: Since we are adopting and advancing industry standards, the NJHIN platform, including the MPI, are easily expanded to regional and national levels. Our plan is to connect with other health care stakeholders across state borders to continue to facilitate identity resolution efforts.

— Lee DeOrio is the editor of For The Record.