• Can duplicate records be eliminated?

    Operational and health analytics benefits from EHRs can be diminished by duplicate records. Minimising them’s a step forward, but can they be eliminated. Northwell Health in New York State thinks they can. Its case study, available from Health IT Analytics, describes its plan.

    Eliminating Duplicate Records Once and for All says after implementing its Master Patient

    Index (MPI), it still had a large and growing queue of potential duplicates in over two million records that needed manual reviews to resolve. It tied down health workers’ time. Northwell’s solution was to deploy Verato Auto Steward™ which:

    Reduced task queue by 87%Shifted staff from tedious task review to higher-value projects.

    A significant benefit is staff liberated from resolving duplicate records are now redeployed to training other people on creating accurate records and preventing duplicates. The case study doesn’t estimate when the lower, 13% duplicate rate’ll be eliminated, but it does show that it it needs two initiatives.

    As Africa’s eHealth programmes expand EHRs, Northwell’s lessons are:

    Include a patient matching systemBegin to redeploy staff from patient matching to training staff dealing with patient identification and managing EHRs. While duplicate records may not be eliminated for some time, or maybe not at all, the two initiatives will enhance the benefits from EHRs. The longer it’s deferred, the bigger the removal task will be.

  • Duplicate patient records keep turning up

    Achieving accurate patients’ IDs’s a constant theme of managing EHRs. Duplicate records just won’t go away. University of Washington (UW) Medicine based in Seattle regularly reviews and improves the reliability and accuracy of its EHRs. Cleaning duplicate records is an important part of the task. 

    Its latest initiative, available from EHR Intelligence, is  with Just Associates,  a consultancy that identifies and resolves patient data integrity problems, reveals some critical lessons for Africa’s eHealth. It found that the duplicate rate was significantly higher than the 10% to 20% it usually finds. The main cause was inadequate information. Many records contained only four of six ID components. They’re last name, first name, middle name, gender, fate of birth and social security number. 

    The review identifies the source of ID issues and issues that create duplicates. This information has helped UW Medicine to develop its strategy and planning to control duplicate rates.

    There’s a long-standing ID challenge. It’s an “uphill battle to dedicate the appropriate resources.”

    Sustaining appropriate staffing levels for ID management’s a challenge. Part of the solution’s relying on ICT tools. An objective’s to using technology to improve efficiency and reduce staff time manually accessing and matching records. It means that staff can then deal directly, efficiently and successfully with awkward ID cases and records.

    A valuable lesson for Africa’s eHealth’s that EHRs alone are not enough. Extra resources are needed to ensure the value of data in EHRs. With a typical duplicate rate of 10% to 20%, any drift in ID management seems to lead to higher rates, so greatly diminished value of EHRs’ data.

  • How can Africa innovate with Unique Patient Identifiers?

    Unique Patient Identifiers (UPI) are both essential and demanding to achieve. They’re harder to use when data’s transferred and shared between organisations. An article from the American Health Information Management Association (AHIMA) proposes innovation with UPIs propriety to vendors and customers as part of the solution. For African health systems, it may improve the current position until national UPIs are in place.

    US provider organisations and payers are innovating with propriety UPIs. A common theme’s dealing with real time or batch queries held by third parties, such as credit agencies. These already have UPIs for their commercial activities. It suggests they offer value to health organisations because commercial entities frequently update and constantly maintain their data, providing current demographics for data warehouses, population health management and illness prevention.

    UPI innovation must be integrated with eHealth governance, which need developing in African health systems. Through eHealth governance, UPI innovation can engage with stakeholders such as:

    Governance teamsProfessional bodiesPatient access and registration staffHealth information management teamsICT teamsData users, such as care coordinators and health analytics teams.

    Their roles can extend to strategic information governance and how innovation and success will be applied. Mitigating risks is another role they can participate in.

    A set of generic questions can help to define UPI innovation:

    Who’s responsible for identifiers’ integrity, especially new identifier created by innovation?When existing data’s augmented with new external data, how is the new data integrated, and what is its lifecycle of managed?What are acceptable uses for the identifiers set by legal and regulatory requirements for UPIs, privacy and compliance?How can organisations incorporate UPI technology with human data stewardship to ensure a compliance and governance?How are discussions and findings from UPI innovation relayed to eHealth governance?How can discussions be for ICT, and people and process supporting eHealth governance?Should innovation deal with data creation for patient access or registration, data governance through procedures, processes and data fields standardisation, or both?How can a sample database be built to support proof of concept and technology?How can enough data be included in UPI innovation projects for rigorous, reliable testing, such as 100,000 records?How can UPI data goals be integrated into data governance programmes?

    AHIMA’s article says organisations and healthcare professionals are cautious in applying innovation to the long-standing UPI challenge. Mismatching records can have profound, adverse effects, so reluctance is reasonable. Despite these anxieties, innovation can still proceed, provided it’s based on a rigorous risk assessment, impact probability, costs and benefits.

    UPI innovation creates two activities for Africa’s health systems. One’s setting up their UPIs. The other is constant, managed innovation with UPIs.

  • Patient identifiers need better security

    At the core of eHealth lies unique patient identifiers. Success’s challenging for all countries, Africa’s health systems have bigger challenges, due in part to mobile populations and partial civil registrations for births, deaths and marriages. Cyber-security’s another challenge.

    Health IT Security has a white paper on it, sponsored by Vasco, a data security firm. The Evolution of the Digital Identity in Healthcare is one of a series of four white papers on patient identifiers. eHNA posts will describe the other three. The central theme’s that it’s no longer enough to know which users have access to a healthcare organisation’s eHealth systems. All types of users, providers, administrative staff and patients must have secure, trusted identities. Relying on static, insecure usernames and passwords is risky and no longer be acceptable.

    Five chapters deal with:

    Regulations and cyber-riskTools for eHealth identities and identity access managementFactors to consider when evaluating security and vendorsPreparing for an eHealth futureResearch sources.

    eHealth regulation and cyber-risk are two essential requirements for Africa. Acfee’s research on eHealth regulation in Africa revealed a significant deficit. Its African eHealth Forum in September 2016 identified cyber-security as a deficit too, so a high priority. As the continent’s eHealth moves towards Health Information exchange (HIE), regulation, cyber-security and reliable patient identifiers become bigger priorities for electronic Personal Health Identifiers (ePHI). Steps for dealing with these include:

    A security risk analysisEncryptionClear, explicit rules for addressable implementationImplement security updates as needed as part of risk managementCorrect identified security deficiencies as part of risk managementMove on from using only a password, its deficient.

    Tools for eHealth identities and identity access management include:

    Identity proofing services, adding extra ICT security layers, such as names, dates of birth, ID card numbers and addressesTwo-factor authentication, such as devices that generate one-time unique passwords  and biometric authenticationAuthentication servers.

    Factors to consider when evaluating security and vendors include:

    Recognising that Identity Access Management (IAM) alone’s not enoughChoosing the right vendor with relevant certifications or certified products is strategicAdopt comprehensive identity verification and authentication solutions.Know how IAM solutions integrate with existing eHealth and avoid cyber-security vulnerabilitiesKnow and mitigate any potential risks inherited from vendors.

    Preparing for an eHealth future must recognise that healthcare’s changing. It’s elevated eHealth way beyond the ICT department’s role. Future eHealth needs safe, convenient and efficient electronic communications. Capacity needs expanding to avoid and remove HIE bottlenecks and sustain prompt, reliable access to patient data. With Africa’s health systems accustomed only to usernames, passwords, and fragmented eHealth and mHealth alongside manual records, they can benefit directly from moving straight to modern, robust and safe patient identifiers. It’s their strategic choices.