Referential Matching Must Be the Foundation of a National Patient Matching Strategy
In early October 2017, a bi-partisan group of senators (Elizabeth Warren, D-Massachusetts, Orrin Hatch, R-Utah, Tammy Baldwin, D-Wisconsin, Sheldon Whitehouse, D-Rhode Island, and Bill Cassidy, R-Louisiana) penned a letter to Gene L. Dodaro, Comptroller General, U.S. GAO requesting that GAO “recommend specific strategies that would improve patient matching, including the consideration of a national patient matching strategy.”
This request was a follow-up to the request in the 21st Century Cures Act, where Congress requires the GAO to “evaluate the efforts, policies and activities of the Office of the National Coordinator (ONC) for Health Information Technology around patient matching methods and areas of improvement.” Furthermore, Congress included language in the FY17 Omnibus spending bill to “aid in the efforts toward an improved national patient matching strategy,” which is a dramatic change from its previous prohibition of HHS from working with the private sector on the development of a unique private identifier (UPI). This new language encourages the Secretary to “provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.”
Verato has developed the next-generation of patient matching technology and has proven that it delivers superior match rates to existing approaches. So, we did what any concerned constituent would do – we wrote a letter! In this letter, we requested that as part of their analysis and recommendation, the GAO consider “Referential Matching” as an alternative solution to existing patient matching technologies that have failed our healthcare system. We sent this letter to key healthcare committees on the Hill and the GAO, offering to brief them on: why patient matching problems exist, how this problem will exponentially multiply as more health enterprises attempt to exchange patient records with each other, and why Referential Matching is the only solution that can achieve accurate patient matching on a national scale. As a result of this outreach, we ultimately met with the Senate HELP Committee (Majority and Minority), health policy advisers for Senators Warren and Cassidy, the House Energy and Commerce Committee, and the GAO. (Fortunately, our offices are a 20-minute Uber ride from Capitol Hill in non-rush hour traffic, 1.5 hour Uber ride in rush hour traffic.)
The ONC has stipulated that by 2018, duplicate rates should be 2% within health systems – and should drop to 0.5% by 2020. Using existing patient matching technology that is based on probabilistic algorithms (i.e. the technology found in Master Patient Index technologies, or MPIs), these match rates are nearly impossible to achieve within the four walls of a health system and impossible to achieve as health systems match and exchange records with each other. And, as more health enterprises attempt to exchange records with each other – across a state or region, for example – errors start compounding, degrading match rates further.
We believe that a national patient matching service or “utility” that uses Referential Matching is the most effective way to achieve inter-enterprise match rates that are mandated by the ONC and, maybe more importantly, that are required to ensure patient safety, improve clinical outcomes, and reduce healthcare costs. Health enterprises would map their patient rosters to identities in a national reference database and, as a result, would be able to automatically associate and link patients that are common across them. More than one reference database could participate in this national service; as long as every reference database is synchronized, patients would still be linked across them. This approach would maintain a consistent match rate across health enterprises participating in this national patient matching service and would not decrement as more organizations joined the network.
In the ONC’s proposed Trusted Exchange Framework and Common Agreement (TEFCA), we recommend that this is a service that the Recognized Coordinating Entity (RCE) would provide to the Qualified Health Information Networks (QHINs).
As we continue to speak with health policy and patient matching influencers – and ultimately the ONC – we recognize that a dramatic shift needs to occur in how healthcare approaches patient matching. Today’s approach is inefficient, costly, time-consuming and still not yielding the required results. The importance of patient matching will be underscored if and when the industry organizes around TEFCA. New methods, technologies, and processes need to be considered; and only then will true interoperability on a national level be achieved.