Six years ago, San Diego Health Connect (SDHC) began as a local health information technology project and has since grown into a regional health information exchange (HIE) that connects San Diego’s three largest health systems and enables the exchange of 3.2 million patients’ electronic medical records (EMRs).
As the HIE has expanded, SDHC leaders have worked to improve the exchange and the quality of the data that’s available through it. That work has come with its share of challenges, and through the use of third-party data quality and data integration technology tools, SDHC has been able to overcome many of these hurdles.
SDHC, a not-for-profit HIE, officially evolved from the San Diego Beacon Community, the largest of the 17 Beacon Community projects that received a total of $250 million in three-year grants from the Health and Human Services Office of the National Coordinator for Health Information Technology (ONC). In April 2010, UC San Diego received a $15.3 million Beacon cooperative agreement from ONC. The San Diego Beacon Community was tasked with building and strengthening local health information technology infrastructure and implementing new approaches for making measurable improvements in the cost and quality of healthcare.
The regional health information exchange was one of the initial projects of that Beacon community, and in 2013, UC San Diego transferred operational and oversight responsibility for the HIE to SDHC. The Beacon grant gave San Diego healthcare organizations a jumpstart for implementing HIE to improve healthcare quality and efficiency, and according to SDHC executive director Dan Chavez, the HIE is further ahead than most HIEs in its development and technological sophistication.
The community-wide HIE now enables the exchange of electronic medical records for 3.2 million patients between 25 different clinics and hospital systems throughout San Diego and Imperial counties, including UC-San Diego Medical Center, Scripps Health, Sharp HealthCare, Kaiser Permanente, Rady Children’s Hospital-San Diego, the U.S. Department of Veteran Services and the County of San Diego Health and Human Services. San Diego is the fifth most populous county in the United States, with three military facilities, 18 federally recognized Indian reservations, 19 acute care hospitals, four non-acute, rehab hospitals, 115 clinics and 9,000 physicians.
SDHC provides healthcare providers with medical records exchange, direct secure messaging and alerts, public health reporting capabilities as well as the EMS Hub, which transmits pre-hospital data from EMS vehicles en route to the hospital.
Throughout the SDHC’s roll out and adoption, the organization’s leaders have faced a significant obstacle that is a common challenge for HIEs—accurate patient identity matching. SDHC is a federated model and does not house medical records, as the clinical data is housed at each of the participating facilities. The HIE uses a master patient index (MPI) as a record locator service to manage the identifying information for 3.2 million people across the San Diego region and to ensure that the records belong to the correct patients. The HIE facilitates 7.5 million transactions a month between the 25 provider institutions.
Using the matching capabilities in the MPI tool, when patient records do not match they end up in an “exception queue.” Due to stringent matching criteria, SDHC’s MPI matching algorithm had, by 2015, excluded 187,000 patient records because of unresolved patient identification, Chavez says. And, each new provider joining SDHC led to more backlog, due to data quality and differences in governance, he says. The HIE also was using a manual data stewardship process. So, the task of addressing the backlog of 187,000 records in the “exception queue” would take eight years for two full-time employees.
Accurate patient identification is not only a data management and data quality issue, it’s also a patient safety issue. As reported earlier this year by Healthcare Informatics, ECRI Institute ranked patient identification errors as second on its list of top 10 patient safety concerns. ECRI Institute analysts discovered that patient identification errors "were not only frequent, but serious.”
In order to develop a better patient matching progress, SDHC convened a working group of 41 HIE members from 13 organizations. As a result of that working group’s efforts, in May 2015, SDHC began a pilot project with health IT startup Verato, a Software-as-a-Service provider that developed a cloud-based patient matching solution.
Accurately identifying people, essentially matching the right record to the right record, is a pervasive problem in healthcare as well as other industries like retail, according to Brent Williams, founder and chief technology officer at Verato.