Evolve from Master Patient Indexing to Identity Interoperability

Transcription

1 Evolve from Master Patient Indexing to Identity Interoperability Mark LaRow, CEO, Verato Thomas Check, President and CEO, Healthix Dr. Shivdev Rao, EVP, UPMC Enterprises February 7, 2017

2 Mark LaRow CEO, Verato Mark is the Chief Executive Officer of Verato. He was formerly at MicroStrategy, a business intelligence software provider, for 14 years where he was the EVP of Products. Prior to MicroStrategy, Mark was with Ernst & Young for 17 years and left as Partner responsible for technical consulting in the east region of the US. Mark holds MS and BS degrees from MIT in electrical engineering and computer science.

3 Verato Overview Verato offers the new best-in-class patient matching technology that leverages a next-generation approach to matching called referential matching. 3

4 Verato Overview Referential matching is different because it uses a highly curated database of identity data for the US population as a universal answer key, which makes it: More accurate Fast to implement Cost less 4

5 Verato Overview Verato is a cloud-based platform that enables health systems, HIEs, and payers to: Turbocharge the matching performance of existing master patient indexes (MPIs) Link patient or member information across databases and enterprises 5

6 Thomas Check President and CEO, Healthix Tom Check is President and CEO of Healthix, which is a Health Information Exchange (HIE) in the State Health Information Network New York (SHIN-NY). Healthix maintains health records of over 16 million patients contributed by their healthcare providers and health plans in New York City and Long Island. Before joining Healthix in 2012, Mr. Check was SVP and CIO at the Visiting Nurse Service of New York, and a senior IT officer at NYU Medical Center and Mount Sinai Medical Center. Mr. Check is a frequent guest speaker and lecturer, focusing on the role of health information exchange (HIE) in value-based care, interoperability standards and HIE privacy policy. Mr. Check holds an MA from New School University and a BA from Boston College.

7 Evolve from Master Patient Index to Identity Interoperability Tom Check, President & CEO, Healthix ehealth Initiative Webinar February 7, 2017

8 the role of Healthix in exchanging information SHIN-NY PRIVATE HIEs PRIVATE HIEs INCLUDE: Health Plans Large Provider Systems PPS Pharmacies More ehealth exchange and SHIEC HEALTHIX Each month receives 33,000,000 Messages and delivers >100,000 Alerts >100,000 CCDs 374 Participants ~ 1,500 Facilities 8

9 sources of data The breadth of data in Healthix is expanding in the number and type of contributors s Independent Physician Practices of All sizes Long-term Care, Nursing Facilities Behavioral Health Facilities Federally Qualified Health Centers (FQHCs) Community Based Organizations Home Care In development EMS Medicaid Claims Health Plans PPS Leads Medicaid Health Homes Independent Pharmacies Independent Labs & Radiology Centers NYC Correctional Health Services All Other Public HIEs in New York State Veterans Administration

10 Shivdev Rao, MD EVP at UPMC Enterprises and Cardiology Faculty at UPMC Dr. Shiv Rao is an Executive Vice President at UPMC Enterprises, where he focuses on clinical innovation strategy. UPMC Enterprises develops and invests in exceptional health care technology to improve the quality and reduce the cost of health care while enhancing the overall patient experience. It is the commercialization arm of University of Pittsburgh Medical Center (UPMC), an integrated health enterprise with more than 25 hospitals and a 3-million-member insurance division. Dr. Rao is also a faculty member in the Cardiology Department at UPMC s Heart and Vascular Institute. He received his BA from Carnegie Mellon and his MD from the University of Pittsburgh.

11 An Introduction to UPMC

12 Integrated Healthcare Delivery and Finance System $13B 65K Annual revenue in M s Employeeslargest private employer in PA Health Plan members

13 UPMC Provider Services 5,000 5,700 Beds Physicians 284K 3.9M Inpatient visits & observations Outpatient visits

14 UPMC Insurance Services Enrolled 262,900 new members in FY16 Total membership over 3,007,000 Largest health insurer in Western PA Second largest provider-owned health plan in United States

15 UPMC Enterprises As an organization dedicated to Life Changing Medicine, UPMC has defined a bold mission: to shape the future of health care through innovation. At UPMC Enterprises, we help bring this mission to life by turning innovative ideas into growing, thriving businesses.

16 Evolve from: Master Patient Indexing to Identity Interoperability

17 Patient identity integration became necessary to tie disparate operational systems together Registration EMR Labs Billing 17

18 A single centralized patient database solved the N 2 integration problem Registration EMR Patient Database Labs Billing 18

19 But 30% of identity data in systems are incorrect or missing Time Name change Address change Phone change change Birth Death 12% change per year Ambiguity Hispanic name hyphens Asian name order Nicknames Junior / Senior Twins 25% of adult pop. Errors Spelling error Transcription error Homonym error Default entries Missing data 6% of data 19

20 Without an MPI, errors compound as more and more databases contribute identities Registration 70% 70% EMR 24% Error-free identities* 70% 70% Labs Billing * 24% = 70% x 70% x 70% x 70% 20

21 With MPI indexing, it became relatively easy to create 70% error-free databases Registration 70% 70% EMR MPI 70% Error-free 70% 70% Labs Billing 21

22 With great effort, MPIs can create 88%-92% error-free databases (i.e., 8-12% duplication rates) Registration Governance Data Standards EMR Data Cleansing 80% MPI 90% Error-free 90% 90% 80% Biometrics Labs Sync Rules Data Stewards Billing 22

23 Indexing = Operational Engineered Governance Rules Registration MPI EMR Labs Billing 23

24 Indexing = Operational Engineered Governance Rules Fast & Flexible to Accommodate Change Registration MPI EMR Labs Billing 24

25 consolidation multiplies the challenges and the effort Health System EMPI 25

26 Innovative new applications will create many new identity connection points Health System EMPI Clinical Applications Patient Engagement Applications Care Management Applications 26

27 Exchanging data with external entities increases the coordination points Health System HIEs Exchange Payers Gov t Entities Health Systems EMPI Clinical Applications Patient Engagement Applications Care Management Applications 27

28 Analytics will introduce new data from non-healthcare sources Health System HIEs Exchange Payers Gov t Entities Health Systems Clinical Applications EMPI Patient Engagement Applications Care Management Applications Analytics Other Data: Marketing Demographic Lifestyle Labs / rad. Rx Digital IoT PGHD 28

29 Patient portals will make every identity error visible to the patients Health System HIEs Exchange Payers Gov t Entities Patient Portal Clinical Applications EMPI Patient Engagement Applications Care Management Applications Analytics Health Systems Other Data: Marketing Demographic Lifestyle Labs / rad. Rx Digital IoT PGHD 29

30 Five trends make patient identity much more important and much more difficult 1 External data exchange 2 Patient engagement 3 Analytics 4 consolidation 5 Innovative new apps 2x More Important Coming soon Today Importance 4x More Difficult Coming soon Today Difficulty 30

31 External Data Exchange

32 Patient Engagement Through portals and personal health apps

33 patient identity matching Increase of 3.0 million facility MRNs Reduction of 3.5 million patient identities Increase of 22% in facility MRNs per patient identity 33

34 Analytics For PopHealth and outcome optimization

35 Consolidation

36 Innovative New Applications and Devices

37 We need Identity Interoperability to go beyond the limits of Indexing 1 External data exchange 2 Patient engagement 3 Analytics 4 consolidation 5 Innovative new apps Identity Inter - operability Indexing 2x More Important Coming soon Today 4x More Difficult Coming soon Today Importance Difficulty 37

38 Healthcare has made great progress in establishing standards for 3 layers of interoperability 3 Semantic Interoperability What is the information? ICD, SNOMED, CCR, DICOM, RxNorm, CPT, NCPDP, LOINC 2 Syntactical Interoperability How do we dialog? HL7, FHIR, ISO 1 Connectivity Interoperability How do we connect? 38

39 Healthcare needs to address a fourth layer of interoperability Identity Interoperability 4 Identity Interoperability Who is the subject? 3 Semantic Interoperability What is the information? 2 Syntactical Interoperability How do we dialog? 1 Connectivity Interoperability How do we connect? 39

40 Identity Interoperability looks like DNS for identities Identity Interoperability Layer Identity DNS MPI IMPROVE existing MPIs 40

41 Identity Interoperability looks like DNS for identities Identity Interoperability Layer Identity DNS MPI MPI IMPROVE existing MPIs LINK identities with new applications 41

42 Identity Interoperability looks like DNS for identities Identity Interoperability Layer Identity DNS MPI MPI HIEs Payers CMS IMPROVE existing MPIs LINK identities with new applications EXCHANGE information with external entities 42

43 Identity Interoperability looks like DNS for identities Identity Interoperability Layer Identity DNS MPI MPI HIEs Payers CMS Marketing PGHD Lifestyle IMPROVE existing MPIs LINK identities with new applications EXCHANGE information with external entities ENRICH patient profiles with information from external sources 43

44 Questions

45 For more information about Verato Stop by at: Visit us at: Booth #7460 verato.com go.verato.com/overview-video 45