Privacy and Security: Challenges and Opportunities in Healthcare Identity
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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
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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
- 2. My Interest in Identity Management: A Personal Vignette © 2014 HIMSS Paul Brian Contino
- 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 .
- 4. New York City Health & Hospitals Corporation
- 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 .
- 8. The Challenges of Patient Identification
- 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)
- 11. Our Patients are in Motion Year 2010 610,000 migrations
- 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
Editor's Notes
- 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