Monday, December 7, 2015

Finding a standardized combination of patient attributes and standardizing the collection/input of these attributes in provider electronic systems

Over a year ago NAHAM offered recommendations recorded in the Office of the National Coordinator for HIT’s 2014 Patient Identification and Matching Final Report.  Pointing to a standardization of data attributes and their capture in electronic systems –

NAHAM supports continuing efforts to create an environment of positive patient identity and believes that the standardization of patient identification protocols and technologies are important means to this goal.  NAHAM is investigating appropriate third factors to enhance positive patient identification.  NAHAM supports the development of standards for data attributes in electronic systems, whether clinical or administrative, and enhanced common capabilities for all health data systems to input standardized data….

This reference to “appropriate third factors” is a call on providers to go beyond The Joint Commission’s National Patient Safety Goal requirement that at least two patient identifiers be used.  While it can be acknowledged that this requirement speaks primarily to the clinical setting, it is a benchmark for Patient Access as well.  NAHAM’s recommendation call for an additional set of patient identifiers, ideally standardized both in combination and means of collection so that all healthcare systems are tracking the same data in the same manner, using the same recording protocols.  NAHAM’s recommendations to the ONC also included a call for standardized EHR technology solutions that would support the standardized patient identification attributes –

Ongoing education and training are also important to ensure personnel at all levels understand the important roles patient data input and patient identification protocols serve in enhancing patient safety.  NAHAM supports Stage 3 Meaningful Use requirements to improve patient matching and supports a comprehensive approach that includes the standardization of patient identification attributes, the development of standards for EHR technology solutions, and the development of best practices and protocols for data input. This would include regular feedback from supervisors and audits for quality control.

The same ONC report, based on the input of a number of stakeholders, including NAHAM, recommended the following data attributes: First Name, Last Name, Previous Last Name, Middle Name or Middle Initial, Suffix, Date of Birth, Current Address, Historical Addresses, Current Phone Number, Historical Phone Numbers, Gender. Whether these are the ideal data attributes is arguably subject to debate; however, we do have a general idea of what attributes are most commonly captured.

The results of an informal NAHAM survey presented at the Patient Identity Integrity Symposium held prior to the 41st Annual Educational Conference and Exposition showed that over 80% of respondents indicated that their systems collected the following patient information: Name (First and Last), Home Phone Number, Work Phone Number, Date of Birth, Gender, Next of Kin, Next of Kin Relationship, Guarantor Phone Number, Primary Physician, Insurance Information, Medical Record Number, Billing Address. 

Next of Kin, Next of Kin Relationship, Medical Record Number, and Billing Address fall out when looking at what 90% of respondents collect.  When looking at the common identifiers for all respondents, patient Work Phone Number and Primary Physician fall out.  The survey showed that 100% of respondents collect patient Name, Home Phone Number, Date of Birth, Gender, Guarantor Phone Number, and Insurance Information. 

We also have some metrics on the key patient identifiers or traits: Validity (is the trait known to be correct?), Distinctness (is the trait able to uniquely identify an individual?), and Stability (how much does the trait remain constant over the lifetime of the individual?).  The recent Sequoia Project's Framework for Cross-Organizational Patient Identity Management (Draft for Public Review and Comment: November 10, 2015) rated these characteristics along with Completeness (at what rate is the trait captured and available?) and Comparability (noting that numbers such as SSNs are easier to compare that free text such as addresses).  Last Name, First Name, Gender and Date of Birth scored well enough to be considered desirable traits, and Postal Code and Primary Phone Number were identified as promising, although Postal Code in particular scored low for Stability.  Ethnicity and Race scored high and very high for Comparability and Stability but comparably lower for Completeness, Validity and Distinctness. 

When looking at combinations of these traits, the following had the highest levels of Completeness: FN+LN+DoB, FN+LN+DoB+Gender, and FN+LN+DoB+Gender+Zip Code (first 5 digit).  This last combination scored highest for Uniqueness, second only to FN+LN+DoB+Gender+SSN (last 4 digits) – although this combination scored among the lowest for Completeness.  The Social Security Number scored low for Completeness and Validity, while scoring high for Distinctness, Comparability and Stability.

So, what combination of attributes could become the basis of a national standard?  Do phone numbers, historical addresses, or next of kin and relationship aid in maximizing Patient Identity Integrity?  What about the last four digits of the Social Security Number?  What combination of attributes does your organization collect?
We'll leave for another discussion the important milestone of standardizing the collection of these attributes -- meaning the protocols and conventions used in collecting and recording First Name, Last Name, whether to record Middle Name or Middle Initial, and how to agree on conventions such as hyphens (do we eliminate these all together?), titles, and generational titles - Junior, Senior, etc.

Let us know what you collect, your thoughts on standardization of how we collect this data, and what combination of attributes could serve as a national standard.

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