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How One HIE is Solving its Unique Patient Matching Problem

January 18, 2018
by Rajiv Leventhal
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Experts attest that the entire operation of an HIE depends on proper patient matching

Across the healthcare ecosystem, many experts feel that the lack of a nationwide patient matching strategy remains one of the largest unresolved issues in the safe and secure electronic exchange of medical data.

Historically, patient matching has been important within organizations to help identify duplicate medical records. When master patient indexes (MPIs) moved from paper to electronic, organizations gave little thought to data exchange, data formatting, or how data is entered into a person management system, according to an AHIMA (American Health Information Management Association) "perspective" on the topic.

Indeed, as the AHIMA whitepaper continued, “Traditionally, patient matching has been done by health information management professionals who manually review possible duplicate patients and manually update paper and electronic systems as needed. Manual review will not be sustainable in the future because electronic health records (EHRs) have created a vast amount of data that puts an undue budgetary burden on the HIE (health information exchange) to employ additional staff responsible for ensuring data integrity. Currently, organizations are matching patient records within their own systems, but face challenges in incorporating patient matching techniques across care settings and different EHR systems.”

As such, stakeholders are looking for a solution. As John Halamka, M.D., CIO of the Boston-based Beth Israel Deaconess Medical Center put it in a recent Healthcare Informatics podcast, “What if the government helped us create a nationwide patient matching strategy? And whatever that is—it could be a thumb print, facial recognition, a retinal scan, a combination of demographics—the problem today is that we are asked to do all this care coordination but we have no idea who any of our patients are. If you are Maureen Kelly and you’re Irish and live in south Boston, you might as well be Jane Smith. So the government can help us with this.”
 

A Unique Challenge for HIEs

HIEs specifically face a significant challenge with matching and linking patient identities because of the diversity and independence of the institutions they serve. David Horrocks, president, Chesapeake Regional Information System (CRISP), a regional HIE serving Maryland and the District of Columbia, notes that at the very core of an HIE—as documents and records are pulled from organizations—is assembling them for a particular patient. “So [you want] the ability to say that this lab result that comes from Saint Agnes Hospital [in Baltimore] is for the same person that is currently admitted at the University of Maryland Medical System,” Horrocks explains.

“The matching is utterly foundational to what we are doing. And our challenge is that we don’t control the capturing of the demographic information and we don’t always get the cleanest information coming back from participating organizations,” he continues, noting that addresses are not always updated, misspellings occur, and the ability to match on the demographics that the HIE receives can be limited. “We do probabilistic matching, and we tune our algorithms so that a false positive is exceedingly rare, but in doing so we tolerate a fair number of false negatives,” Horrocks says.

David Horrocks

For an end-user of the services—a clinician, for example—CRISP will present a possible match of duplicates. If CRISP is unsure that two records are for the same person, the HIE’s team will show those records to the clinician. “It could be two different people who might be the same and then we rely on the doctor to make a judgment as to whether they should or shouldn’t rely on the information,” Horrocks says.

And if the HIE receives too much poor data, the result of that will be multiple duplicates. “So you might have three or four identities, and for a doctor, this is a very classic case for us, trying to understand if the person right in front of him or her has already has received his or her opioid prescription, for example,” Horrocks says. “You have to go through each of the four [records], open the record, see if there is an opioid and then make a determination to see if it’s the same person. Clinicians hate that.”

As such, CRISP’s leadership team turned to the McLean, Va.-based software company Verato a little over a year ago with the idea to bring “richer” information to the table via the vendor’s cloud-based matching platform. The solution doesn’t provide a different algorithm; it “hydrates” the end-user’s records with additional information, Horrocks explains. So CRISP will send its identities to the platform, which then process and hydrates them with additional information, before sending them back to the HIE nearly immediately. And now that they’re hydrated, they run through the same algorithm as they did before in CRISP’s MPI, and they “match,” whereas they didn’t before. “In our proof of concept we have eliminated hundreds of thousands potential duplicates in our MPI,” Horrocks says.

If someone has changed addresses, for instance, the platform will look at other records to confirm that it’s the same person that has moved from place A to place B. CRISP can now more definitively match those individuals and the clinician at the point of care is being shown one or two records—not four. “And if you’re the person calculating a clinical quality measure such as readmissions, you have more confidence in saying ‘yes, this person who showed up three weeks later at this hospital is in fact the same person. So you have more confidence in your quality measures. The fact that they are bringing the additional data is key and is a game changer,” Horrocks attests.

What’s particularly frustrating for CRISP—and for other HIEs that are continuing to grow—is that the more participants that get added to the network and the longer it is in operation, the tougher the problem becomes. Horrocks notes that over time, the likelihood that a person has moved, got married, or has had some major demographic change simply increases. “So as an HIE, the more successful you are the bigger the challenge it is,” he says.

Officials from CRISP and Verato say that before implementing the Verato Universal MPI last year, CRISP’s conventional MPI was flagging nearly 6,000 incoming patient identities as potential matches that needed to be manually resolved. But these flags were being generated faster than they could be resolved, leading to a growing backlog of potential matches. With the addition of the patient matching solution, CRISP has worked through more than 2.2 million of these potential matches in its backlog.

What’s more, says Horrocks, “What we look at is the percentage of ‘close matches,’ and if we’re reducing that close match number, the result in the field is that people won’t be seeing those duplicates.” To this end, CRISP has also achieved an 8.5 percent reduction in “close demographic matches,” as a result of the Verato services, over a period when it added 2.4 million new identities (people) composed of more than 25 million records.

Verato CEO Mark LaRow notes that CRISP became the third HIE to use its platform; but now, the vendor actually has nine HIEs on board. “We’re finding that the HIEs, more than any other healthcare institution, have this patient matching problem,” he says. “Every hospital can control its data to some extent. You can train your registrars and institute new policies and procedures, but the HIEs take whatever the hospital gives it. So maybe hospital X has great [data] but another one in Delaware doesn’t. They all vary and when you have 50 hospitals feeding [the HIE], the errors compound.” As such, LaRow adds, “The entire operation of an HIE depends on matching.”


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Two N.Y. Regional HIEs Partner to Enhance Technology, Services

October 1, 2018
by Heather Landi, Associate Editor
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Two New York regional health information exchanges, HealthlinkNY and HealtheConnections, have formed a strategic partnership aimed at accelerating HIE use by providers. The HIE leader contend that the partnership will provide more value to providers by offering innovative technology, new capabilities, and richer data for participants in the HIE.

The HIEs, which are two of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY), together cover 43 percent of New York State. Binghamton-based HealthlinkNY and HealtheConnections, based in Syracuse, leaders said the partnership will connect providers across much of New York State, from the northern border of New York City, through the Hudson Valley, and throughout the Southern Tier and Central New York to the Canadian border. The partnership is the result of months of collaboration following HealthlinkNY’s decision to seek a strategic partner in 2017.

Staci Romeo, HealthlinkNY’s executive director, said she chose HealtheConnections because their technological platform is “exceptional,” and HealtheConnections’ “quality of services and customer engagement processes completely align with HealthlinkNY’s mission and values.”

“HealtheConnections has proven technology and associated services that create value for providers. We’re thinking progressively and looking to offer resources such as tools to measure quality and support value-based care systems,” Romeo said in a statement. “We want a partner with innovative services and an unwavering commitment to providing value to providers by enabling them to improve care and efficiency, as well as save time and money.”

The announcement came just a few days after HealthlinkNY publicly opposed another regional HIE’s plans to expand its services into HealthlinkNY’s market. In a press release issued early last week, Romeo responded to plans by Hixny, an HIE based in Albany that historically covered north and west of the Capital District, to expand into nine counties in HealthlinkNY’s territory and called Hixny’s move “a case of sour grapes after being passed over during our search for a strategic partner.”

Rob Hack, president and CEO of HealtheConnections, said the strategic partnership was inspired, in part, by a statewide effort to optimize costs and efficiencies to increase use and adoption of regional HIEs and the network that connects them all—the SHIN-NY. “HealtheConnections and HealthlinkNY have a shared vision of using health data to create healthier communities, improve healthcare delivery, and deliver value to providers. This type of progress can only be achieved through enhanced collaboration and looking beyond the status quo.,” he said. “That’s what we’re trying to do here—accelerate the great work that has already begun. The HIE works to its fullest potential when all parties, providers and HIEs alike, work together toward the common goal.”

Romeo said that HealthlinkNY will begin to migrate its current HIE interface to HealtheConnections’ platform in early 2019. With the new platform, users will be able to further filter data, set up advanced alerts and results routing, and have access to more databases, including the New York State Immunization Information System (NYSIS), Veteran’s Administration (VA), and Department of Defense (DOD), she said. Other enhancements include fully integrated analytics and reporting value-based payment support and advisory services; quality measurements; and clinical dashboards that provide usable data to identify gaps in care.

“The user experience is key,” Romeo said of the technology and services. “Both HealthlinkNY and HealtheConnections are coming from a place where we put providers first, and that includes offering providers a nimble and intuitive platform and services that support the way they deliver care and help their organizations save time and money.”

Romeo pointed out an additional benefit to providers: Both HealthlinkNY and HealtheConnections have built “hub” connections to widely-used electronic health records (EHR) systems. HealthlinkNY has 21 hubs and HealtheConnections has 13 hubs.  Combined, providers will have access to 50 different hub and custom connection options, she said.

Hack called the partnership “a game-changer” because together the two entities will be able to accelerate new participant growth, data contributions, development of new analytics, and community health improvement results. “The idea,” said Hack, “is to transform and improve patient care, improve the health of our population, and lower health care costs.”

Together, HealthlinkNY and HealtheConnections will operate a service area that covers 24 counties, more than one-third of the 62 counties in New York State, and connect all of the region’s 66 hospitals, which comprise 27 percent of all hospitals in New York State.

According to HealthlinkNY and HealtheConnections leaders, both HIEs administer collaborative population health improvement initiatives in their regions, and they are the only HIEs in New York State that administer Population Health Improvement Program (PHIP) grants.

Currently, HealthlinkNY’s HIE stretches across 13 counties, and its population health arm manages the Southern Tier Regional Addiction Resource Center. The HealthlinkNY Community Network works with partners on many additional population health efforts in 14 counties in the Hudson Valley, Catskills, and Southern Tier of New York. HealtheConnections has a strong regional presence in 11 counties in the Central and Northern New York regions, where 80 percent of physicians actively use its HIE, and 75 percent of providers contribute data.

 

 

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One New York Regional HIE Opposes Expansion of Another, Highlighting Issues with Competition Among HIEs

September 24, 2018
by Heather Landi, Associate Editor
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In a 2015 report, 84 percent of HIE leaders cited competition among HIEs as a barrier to development
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A New York regional health information exchange (HIE), HealthlinkNY, based in Binghamton, has publicly come out against another regional HIE’s plans to expand its services into HealthlinkNY’s market, saying it creates “confusion and uncertainty” in the marketplace.

Last week, Hixny, an HIE based in Albany that historically covered north and west of the Capital District, announced that it had added nine counties to its territory, specifically Chenango, Broome, Sullivan, Ulster, Dutchess, Orange, Putnam, Westchester and Rockland counties in southern New York. These nine counties are already covered by HealthlinkNY’s network, which covers a 13-county service area spanning the Hudson Valley, Catskills, and the Southern Tier of New York (the Southern Tier encompasses counties of New York west of the Catskill Mountains along the northern border of Pennsylvania).

With the expansion, Hixny now serves 28 counties and the HIE already has updated its website to state that it serves communities from Westchester to the Canadian border and Binghamton to Vermont. Hixny CEO Mark McKinney claims that this area, the Hudson Valley and Southern Tier region, has "historically lagged in connecting providers to one another and collecting patient consent.”

Staci Romeo, executive director of HealthlinkNY, notes that all 35 hospitals in the Hudson Valley and Catskill regions are HealthlinkNY participants. In those nine counties, Hixny has 21 sites and no hospitals, according to Romeo.

Both HIEs are two among the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health and managed by the New York eHealth Collaborative (NYeC). According to the NYeC website, participating healthcare organizations can connect with the QE that best aligns with their business, operational, and service delivery needs. 

HealthlinkNY issued a strongly worded press release late last week in response to Hixny’s expansion plans. “The truth is that an unnecessary expansion into this service area compromises the effectiveness of the Health Information Exchange [HIE],” Romeo said in the press release. Romeo also stated, "While others seek to confuse the marketplace for their own professional gain, our focus is pure: to help providers improve the continuum of care."

During interviews Romeo and Hixny's McKinney both addressed the expansion plans. Romeo says Hixny’s expansion into its territory creates competition between the HIEs and says the competition is a “distraction, it’s confusing for participants and it’s completely unnecessary.”

McKinney says, “The primary reason for us to consider expansion is because patients and providers really are not bound by county borders. We have long been a trail blazer as an HIE both in the state and around the country. From our perspective, reaching into those regions helps to meet the needs of those patients.” McKinney says Hixny officials recognized that there was an overlap of patients seeing providers both in Hixny’s service area and in neighboring counties.

“We looked at data for patients already inside our master patient index, and we saw significant percentages of patients already had records inside our systems, so for those providers and those patients, getting a more accurate and complete record and making that system available to providers seemed like a valuable exercise to bring all that information to one place,” he says. “This gives providers a choice in terms of what they value with regard to the services that are provided.”

According to Hixny’s website, 1 in 5 residents of the Hudson Valley and Southern Tier already have Hixny records, and that figure increases to more than 1 in 2 in counties neighboring Hixny's established service area, the website states.

HealthlinkNY's service area

Hixny's service area

McKinney also notes that it is not uncommon for multiple HIEs to serve multiple markets and he believes its beneficial to have two HIEs serving the same counties. “I think what’s most important is to meet the needs of patients and providers. Ultimately, it’s about patients and providers and making sure they have access to the information that they need,” he says.

And in response to Romeo’s statement that Hixny’s expansion creates “confusion and uncertainty in the marketplace.” McKinney says, “I can’t comment on her response; what I can say it that we’re very committed to our expansion and delivering the data and the information that will improve care and lower costs for patients and providers in the region.”

Hixny (formerly known as the Health Information Xchange of New York) launched in 1999 as a collaboration between Iroquois Health Care Alliance, which represents upstate hospitals, and the New York Health Plan Association. The HIE currently serves 1.7 million patients.

Regional HIEs enable provider organizations to access and exchange health information with participants in their region, and, in New York State, all eight QEs connect to SHIN-NY, which acts as a hub to provide access to patients’ health information statewide. When contacted for comment, Valerie Grey, executive director of the New York eHealth Collaborative (NYeC), stated, “Ultimately, our role is to help expand participation in the information network and support all of our partners in that process. We’re going to continue that work with each of our eight regional networks because increased participation will improve health outcomes across New York.”

Historically, HIEs separately increase their networks within their agreed-upon geographic areas, while there also is a great deal of collaboration between regional HIEs. However, one challenge for many HIE leaders is determining how to exchange information with competing organizations.

Healthcare researcher Julia Adler-Milstein, Ph.D., who has done extensive research on HIEs, says there are regions with multiple HIEs operating and competition among HIEs is a common issue, although it’s often discussed in “backroom” conversations. Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, at the University of California San Francisco.

Three years ago, Adler-Milstein was part of a team of researchers from the Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan, School of Information that published research examining health IT adoption, including the advancement of community HIEs. As part of that study, the researchers surveyed HIE leaders about barriers to development, and 84 percent of respondents cited competition among HIEs as a barrier to their development.

In Opposing Hinxy's Expanion, HealthlinkNY Claims "Sour Grapes"

HealthlinkNY officials also take issue with the wording of Hixny’s press release stating that information sharing "historically lags" in the Hudson Valley and Southern Tier region, which is HealthlinkNY's territory.

McKinney says, "There has been public information that has demonstrated that the growth of SHIN-NY across the state has been uneven and so we’re basing [that] on some of that information that has demonstrated that certain areas have grown faster than others." He adds, “We think our press release stands for itself, in terms of demonstrating that there is a need for Hixny to deliver the data and the information that will improve care and lower costs for patients and providers in the region.”

In HealthlinkNY’s press release, Romeo said Hixny’s claims against HealthlinkNY’s impact and progress are "completely unfounded.”

HealthlinkNY, which launched in 2005, has all 35 hospitals in the Hudson Valley and Catskill region participating and sending data to their HIE, as well as 1,207 sites, according to Romeo. HealthlinkNY also recently hit the two million patient consent mark and has 374 participating provider organizations, up from 271 at the end of 2017, according to Romeo. HealthlinkNY also administers two Population Health Improvement Programs (PHIPs) in the Hudson Valley and Southern Tier. HealthlinkNY’s service area population is just shy of 2.9 million residents and includes nearly 1,800 participating locations.

Further, Romeo stated in the press release that Hixny’s claims “sound like a case of sour grapes after being passed over during our search for a strategic partner.” HealthlinkNY has entered into strategic partnership discussions with HealtheConnections, another HIE located in Syracuse that serves central New York, and Romeo stated, “HealthlinkNY had recently advised Hixny that they did not make the cut.”

When reached for comment on Romeo’s claim, McKinney responded, “Hixny’s strategy for expansion is solely based on getting providers data that is complete, accurate and up-to-date and supporting the success of the SHIN-NY by improving the overall health of our communities.” 

Romeo notes that HealthlinkNY has significant plans underway in the Hudson Valley and Catskill regions to increase its presence and breadth of services offered. As part of this strategy, HealthlinkNY is looking to work with a strategic partner with “innovative services and an unwavering commitment to providing value,” she says. After interviewing potential partners, HealthlinkNY decided to collaborate with HealtheConnections.

Romeo said in the press release that HealthlinkNY entered discussions with HealtheConnections because “they are in alignment with us with respect to mission, best practices, services, capabilities, and culture.” She further stated, “They also will help power a more sophisticated technology platform as well as a complementary program for population health, critical with today’s burgeoning opioid crisis and the need for increased access to mental health services. We want to take this to the next level.”

Romeo further expanded on the partnership: “The combination of services currently provided by both QE's will be expanded by this partnership. Just a few examples are: additional functionality regarding actionable analytics, HEDIS reporting, as well as alerts provided how and when participants need them. We are looking forward to synergies and shared best practices between both organizations.”

 


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Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent, according to Hixny officials.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”

 

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