eHealth in Europe: Unified View of Patient Data enables Better Healthcare at a lower cost

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This paper considers the situation in Europe – that is, broadly, the European Economic Area (EEA) and Central and Eastern
Europe – and shows how sophisticated data matching and record linking techniques, such as an enterprise master person
index (EMPI), support rapid, accurate patient identification which is essential to enabling effective health information
sharing to deliver better healthcare at lower cost.

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eHealth in Europe: Unified View of Patient Data enables Better Healthcare at a lower cost

  1. 1. IBM Software Group, Information Management HealthcareWhite PaperUnified View of Patient Dataenables Better Healthcareat a lower cost
  2. 2. 2 Unified View of Patient Data enables Better Healthcare at a Lower Cost Executive Summary Unified View of Patient Data enables Better Healthcare at a Lower Cost The European Union, Central Europe and countries around the globe have recognised the value of care coordination and are building or updating their eHealth infrastructure to connect and share information. Accurately identifying and matching patient records across systems to create a unified view for eHealth applications is a must. However, it is not an easy challenge to solve. • National identifier systems which are capable of validating insurance coverage or administering payments are not typically built to support the level of accuracy and complex, real-time information sharing required to enable coordinated care across a broad and distributed set of healthcare providers. • Legacy systems have a lot of rich historical data that is important to include in a person’s medical record. These same systems bring special difficulties to many organisations that can make it difficult, even impossible, to add a universal health identifier (UHI) as an attribute. • Protecting patient privacy is a significant concern due to the sensitivity of health information. Most if not all countries have regulations limiting the use and distribution of a patient’s health information. • Government authorities and healthcare providers alike are challenged with providing cross-border healthcare to an even wider range of citizens of very different cultural and linguistic backgrounds. And semantics and culture vary widely across the continent. Rapid, accurate patient identification, coupled with a unified view of the patient’s medical history at the point of care irrespective of where the data is held, is vital to meeting the EU’s goal of providing better healthcare at lower cost. This paper considers the situation in Europe – that is, broadly, the European Economic Area (EEA) and Central and Eastern Europe – and shows how sophisticated data matching and record linking techniques, such as an enterprise master person index (EMPI), support rapid, accurate patient identification which is essential to enabling effective health information sharing to deliver better healthcare at lower cost.
  3. 3. Healthcare 3 Unified View of Patient Data enables Better Healthcare at a Lower CostContents Accurately linking patient records across disparate3 Introduction and Overview systems to enable secure information sharing is4 European challenges in linking information critical to the success of any eHealth initiative.5 Building and maintaining a high Healthcare leaders around the world recognise the need to leverage quality data foundation information and communication technology (ICT) to improve6 The power of the enterprise master person efficiencies, enable coordinated care delivery and control costs. A index (EMPI) significant challenge, however, is harnessing and managing information about a patient when it is distributed across providers in individual system6 The importance of speed, flexibility and scalability silos that aren’t built to interoperate or share information. of the EMPI6 Following standards and protecting privacy Aggregated information obtained from procedures, hospital stays or with the EMPI outpatient visits, as well the effects of attendant social care or responses to medication, is valuable for coordinated care. When anonymised, it7 Conclusion can also be used in research and analysis for future planning and delivery of healthcare services. The European Union, Central Europe and countries around the globe have all recognised the value of care coordination and are building or updating their eHealth infrastructure to connect and share information. Accurately identifying and matching patient records across systems to create a unified view for eHealth applications is a must. However, it is not an easy challenge to solve. The European Parliament particularly notes, in its reports and discussions on cross-border healthcare, the need to improve electronic systems for patient identification. The EU’s eHealth Action Plan writes of ‘the need to identify a person unambiguously’ as being ‘an important component’ of any national or regional eHealth infrastructure. Canada Health Infoway, Singapore, Australia and many U.S.A. health information exchanges call for patient and provider registries as part of their electronic patient record (EPR) infrastructure to ensure accurate and secure patient identification and health information sharing.
  4. 4. 4 Unified View of Patient Data enables Better Healthcare at a Lower CostIn response to the realisation that patient identification is Irrespective of the initiative or the eHealth approach, theparamount for eHealth, some governments have issued health common element is the patient. It is important to have robust,ID cards or extended the use of a national identifier (beyond a powerful and flexible systems capable of interoperating in abenefits and payment system) as a means to identify patients. standardised way to identify patients rapidly and accurately,Developing or extending the use of a health identifier is link the right records to the right patients and securely providesomething which appears straightforward, but it’s harder than a full view of their medical history to authorised providers,it looks. In fact, it can be difficult at best, and many times something which a good enterprise master person indeximpossible, to add a health identifier to a legacy system to (EMPI) is proven to help deliver.enable accurate identification and information sharing withother systems.National identifier systems which are capable of validatinginsurance coverage or administering payments are not typically Sorting out the Jones’s records Wales is a country of three million people bordering thebuilt to support the level of accuracy and complex, real-time west of England and washed by the Bristol Channel andinformation sharing required to enable coordinated care acrossa broad and distributed set of healthcare providers. Nor are the Irish Sea. People variously speak English or Welsh orthey built to support privacy requirements that many regions both. It’s part of the UK but has many powers devolved to the Welsh Assembly, health included. In 2003, theor countries are adopting. Assembly established the Informing Wales Health Care Programme (IWHCP) to improve Welsh healthcare,European challenges in accurately something now developing well.identifying and linking patient healthinformation Information was fractured and scattered not only throughThere are special challenges to European healthcare. the seven health boards but also among both hospitalsSemantics and culture vary widely across the continent. and individual departments. Patients had a multiplicity ofCertain languages dominate but there are perhaps forty in identifiers and there were numerous duplicate patientreasonably common use in various countries and regions. records. Further, some Welsh names are widespread and the likes of Margaret Jones or Thomas Davies were atThe patient’s language and that of whoever enters data into the high risk of having their records confused with those ofsystem may vary and mistakes will inevitably occur. In addition, others.government authorities and healthcare providers alike arechallenged with providing cross-border healthcare to an even IWHCP identified correct patient identification as a keywider range of citizens of very different cultural and linguistic need and contracted with IBM to deploy the IBM Initiatebackgrounds. Patient EMPI as part of the eHealth architecture. This brought additional benefits to the NHS Trusts mergerFor example, the project Smart Open Services for European programme and helped the development of the WelshPatients (epSOS) exists to develop and evaluate a service Clinical Portal.infrastructure demonstrating cross-border interoperabilitybetween electronic health record systems in Europe. Also, the Earlier, it was difficult and time consuming to searchSingle Market provisions generally allow any EEA national to several administrative systems to track down patientlive and work in any part of the community or EEA area, information. With the IBM Initiate Patient EMPI at theshowing their entitlement typically through possession of the foundation of the eHealth architecture in Wales, clinicalnow mandatory European Health Insurance Card (EHIC). staff now see unified patient views, learn instantly whereThese broad-based initiatives, coupled with the local supporting records are held and can order tests online.challenges of providing care for a culturally diverse population, “Much quicker,” enthused one doctor. “It’s just likebring some complex issues when it comes to interconnecting internet shopping!”systems and securely and accurately sharing information.
  5. 5. Healthcare 5Building and Maintaining a High Quality An IBM study of one nation’s highly controlled universalData Foundation identifier found some surprising figures that indicatedLife events such as moving house or work, changing names, data quality issues and missed opportunities for linkingdivorce or marriage, or even death, are consequent to data patient records together for the EPR. The study showed:degradation within a system and also impact the ability tomatch and share health records. This is a serious but not • 4%–5% of the records in the system were duplicates.uncommon problem. Many estimates indicate data inaccuracies • Of the 13 million records spread across 12 differentthat exceed 8% of a client file. In a million record database, systems, only 5.1 million were unique. This indicates athat would be 80,000 inaccurate records. high degree of overlap across organisations, which means that patients have records in more than oneCleaning data is expensive and time consuming. In business, system that are not being linked together.poor data quality or inability to identify relationships across • Nearly 800,000 (6%) of the records had missing orsystems means poor customer service and decreased profits; in inaccurate dates of birth.healthcare, it means poor service delivery, increased costs and, • Nearly half (45%) of the phone numbers held wereat worst, compromised patient care and malpractice suits. wrong, including 28% of the home phone numbers.Consider the time and cost involved for patients who have to This impacts a physician’s ability to contact and followundergo duplicate testing or who encounter adverse drug up with patients.interactions because records are not properly linked acrosssystems to create the single Electronic Patient Record.Computer systems are very good at finding records that give The table below illustrates data from a country that has aan exact match. If a patient is allocated a unique identifier, with national identifier. The health ministers and health ITall the relevant records linked to that, and if the identifier is managers believed a national identifier would suffice forentered correctly, then that person’s relevant records will be eHealth Initiatives. An attribute validity study was conductedfound. This is the argument for numbering passports and to determine quality checks on the capture rates. The data indriving licences on a national scale. The logic flaw is not to do the table shows less-than-adequate capture rates on the healthwith how computers work but in understanding how society identifier, phone and forename (middle), which degrades theand human beings behave in real life. ability to accurately identify the patient and create a unified view for health information sharing and coordinated care.In healthcare, different clinical departments and services often These low capture rates on key identifying attributesuse their own identifiers. Many do not use the national compromise the eHealth initiatives.identifier as the primary means of identification, or at all, dueto privacy concerns, system functionality limitations or simply Attribute Validitybecause the systems are older than the number itself. Patient Administration Accident andSemantic and cultural differences can lead to difficulties in System (PAS) Emergency (A&E) Source System ( 1,118,057 records) (208,000 records)finding records. If a record is not found, then typically a new Surname 100% 100%patient ID will be created which may or may not include the Forename (First) 100% 100%person’s nationally assigned number. Forename (Middle) 29% 24% Gender 98.8% 100%Although countries have national or health identifiers, thatdoes not mean that everyone “always” has one or that it is Birth Date 90.6% 99.2%captured “100% of the time”. Reliance on any one data point is Health Identifier 41.9% 10.7%risky. Using an array of data points is necessary to achieve the Phone 35.8% 90.9%highest percentages of accuracy when linking records together. Address 99.5% 99.2%
  6. 6. 6 Unified View of Patient Data enables Better Healthcare at a Lower CostThe power of the enterprise master • IBM Initiate Patient EMPI works in real time with sub-person index (EMPI) second response capabilities to enable core healthcareHealthcare is complex, with multiple disparate systems that applications to accurately identify the right patient and createeach ascribe to different data management techniques. While the unified view of health history, lab results andthe universal health identifier (UHI) can be very useful in pharmaceuticals for authorised healthcare providers.managing identification, it really is merely one attribute amongmany that should be used to identify a patient and effectively It’s important that systems on which care delivery organisationsshare information across providers for coordinated healthcare rely should be both scalable and able to interface with legacydelivery. systems. One of the worst experiences organisations have is to find they’ve outgrown the computer applications on whichAn EMPI, especially one that employs probabilistic matching, they rely and to have to face the disruption of taking a majorachieves highly reliable matching and linking of results to step to something new.create a unified view of a patient for the healthcare system. • IBM Initiate Patient EMPI is designed from the start to scaleFor example, the probabilistic matching in IBM Initiate – if more capacity is needed due to expanding the number ofPatient, an EMPI, is proven to be invaluable for overcoming systems, records or patients, then simply expanding thethe semantic and cultural differences that exist in Europe. capacity of the solution is all that is required. • Legacy systems have a lot of rich historical data that is• It compares a number of attributes such as name and important to include in a person’s medical record. These same demographic data such as date of birth, gender, phone and systems bring special difficulties to many organisations. For address, along with the health identifier, to identify the best example, it may be impossible to add a UHI as an attribute. possible match. • In contrast, the IBM Initiate Patient EMPI does not solely• It accounts for common data matching challenges such as rely on the UHI for patient identification. It captures patient nicknames, contractions, name transpositions and phonetics records using a multitude of identifying attributes along with and homophones, such as Tom, Thom and Thomas, as well as the UHI and links to other systems to enable a single, unified Gerald and Jerold. view of the patient – a much cleaner, faster and more efficient approach.The probabilistic matching of IBM Initiate Patient EMPIprovides a way of rapidly identifying the commonality across a Following standards and protectingrange of records despite their variation, so that authorised privacy with the EMPIclinicians checking their patient’s record in the EPR or other Implementing information systems that are standards-based isconnected system can be confident that the view is both important to ensure long-term viability and interoperability.accurate and complete. This complete view saves time and IBM has consistently been a leader in standards developmentmoney, and improves the overall experience and safety for the and compliance.patient. • IBM is one of the early members of the Continua HealthThe importance of speed, flexibility and Alliance, a non-profit open industry organisation of healthcarescalability of the EMPI and technology companies who collaborate to promoteHealthcare is increasingly fast moving. Knowing immediately interoperability according to standards-based approaches inwhether a person in the Accident and Emergency unit is order to improve the quality of healthcare delivery.diabetic or intolerant of certain medications or has a cardiac • IBM is also a long-standing member and active participantabnormality may be critical in deciding how to act safely. For with IHE (Integrating the Healthcare Enterprise), angeneral practitioners, it may be important to know whether a organisation which promotes standards-based healthpatient is continuing with prescribed drugs – in this case, information sharing through real-world use cases.seeing immediately on a patient’s unified record that a regular • IBM Initiate Patient has been consistently compliant withweekly prescription has not been collected could be important HL7 requirements and offers an open platform which allowsevidence. for application development.
  7. 7. Healthcare 7 existing system environment to provide quick time to value Health information sharing across a and ongoing returns on investment as your business needs hospital network evolve. Belgium is a federal state of eleven million people where three different native languages are spoken: Dutch, Protecting patient privacy is a significant concern due to the French and German. This adds considerable complexity sensitivity of health information. Most if not all countries have to health information systems. regulations limiting the use and distribution of a patient’s health information. In order for providers and patients to A large public hospital network wanted a means of embrace the benefits of health information sharing, they must accurately identifying and matching patient records be confident that the data is protected and only shared with across its five hospital sources to facilitate the sharing of authorised individuals. data for registration purposes and the clinical portal. • IBM Initiate Patient EMPI does not require data to be moved Data quality and inability to share information across to a central location. Instead, it creates a virtual index which facilities was an issue prior to implementing IBM Initiate points to where the patient information resides. Patient EMPI. Some 40% of patients are treated in more than one hospital; because each hospital has a distinct When the downstream applications call upon the index for database and its own system of codes, it was impossible to patient identification, a virtual composite view of the patient is get unified views of patient histories. The existing systems returned linking all records for the patient together. The view were using exact matching techniques for searching; can be comprehensive or limited in order to support local because this made it difficult to find records, this resulted privacy requirements, the unique needs of each patient in the creation of many duplicate records. In addition, administration or clinical system, and organisational more than 20% of patients didn’t have a health identifier preferences. on file, so using the Belgian health identifier was not a reliable option for matching and linking records for Conclusion health information sharing. An EMPI enables secure and accurate health information sharing across disparate healthcare providers by matching and IBM Initiate Patient EMPI is helping greatly. Records are linking the right records to the right patient. This is something matched and linked across systems to create a single view which is difficult to achieve with the use of a UHI on its own. even when data is incomplete. This has facilitated use of the new clinical portal, where authorised physicians With the EMPI at the foundation of the eHealth access a consolidated view of a patient’s records regardless infrastructure, healthcare organisations can deliver more of which facility they visited. comprehensive and accurate information to applications like patient administration systems, electronic patient records, clinical portals and more, without solely relying on the UHI.In today’s volatile economic climate, it is critical to maximisethe value of existing resources as well as invest in solutions that Rapid, accurate patient identification, coupled with a unifiedwill result in quick return on investment. view of the patient’s medical history at the point of care irrespective of where the data is held, is vital to meeting theAn EMPI is a technology that can be implemented alongside EU’s goal of providing better healthcare at lower cost. This isexisting systems to make an immediate impact on productivity what the sophisticated technology of the IBM Initiate Patientand have a long-term impact on the health information sharing EMPI helps deliver in conjunction with the UHI and as part ofrequired to enable coordinated care. the broader eHealth infrastructure.• IBM Initiate Patient EMPI is highly configurable and adaptable. It can be implemented in a few months into your
  8. 8. 8 Unified View of Patient Data enables Better Healthcare at a Lower CostAbout IBM Information Managementsolutions for healthcareThe journey to sustainable healthcare systems starts with asmarter approach to information sharing. IBM InformationManagement solutions for healthcare deliver master data © Copyright IBM Corporation 2011management (MDM) capabilities that help stakeholders toconnect and share clinical information accurately, securely and IBM Global Services Route 100cost effectively. IBM Initiate Patient and IBM Initiate Provider Somers, NY 10589are a trusted foundation for information sharing around the U.S.A.globe; they help healthcare organisations improve Produced in the United States of Americacollaboration to increase quality of care, streamline compliance November 2011and increase patient and provider satisfaction. All Rights Reserved IBM, the IBM logo, ibm.com, Initiate and Cognos are trademarks orFor additional information registered trademarksof International Business Machines Corporation in the United States, other countries, or both. If these and other IBMContact your IBM sales representative or IBM Business trademarked terms are marked on their first occurrence in this informationPartner, or visit us at: ibm.com/Infosphere/Patient with a trademark symbol (® or ™), these symbols indicate U.S. registered or common law trademarks owned by IBM at the time this information was published. Such trademarks may also be registered or common law trademarks in other countries. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at: ibm.com/legal/ copytrade.shtml Other product, company or service names may be trademarks or service marks of others. References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates. Please Recycle IMW14595-USEN-00

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