Patient Matching in the Indiana Network for Patient Care Shaun Grannis, M.D. M.S. The Regenstrief Institute and Indiana University School of Medicine.

Patient Matching in the Patient Matching in the Indiana Network for Indiana Network for

Patient CarePatient Care

Shaun Grannis, M.D. M.S.Shaun Grannis, M.D. M.S.

The Regenstrief Institute andThe Regenstrief Institute and

Indiana University School of Indiana University School of MedicineMedicine

Regenstrief BeginningsRegenstrief Beginnings

Endowed by Sam Regenstrief - Endowed by Sam Regenstrief - inventor of the low cost dishwasherinventor of the low cost dishwasher

Obsessed with process Obsessed with process improvementimprovement

Supported the creation of the Supported the creation of the Institute in 1972 to apply process Institute in 1972 to apply process improvement to medicineimprovement to medicine

Regenstrief Institute Regenstrief Institute

Regenstrief tasked in 1972 to “stitch” Regenstrief tasked in 1972 to “stitch” silos of medical information together -> silos of medical information together -> the Regenstrief Medical Record System the Regenstrief Medical Record System (RMRS/Wishard Memorial Hospital) (RMRS/Wishard Memorial Hospital)

In 1994, began stitching together In 1994, began stitching together information across institutions information across institutions (INPC/Indianapolis)(INPC/Indianapolis)

In 2003, working towards stitching the In 2003, working towards stitching the state together (INPC/Indiana)state together (INPC/Indiana)

A “Big” Repository by US A “Big” Repository by US StandardsStandards

In the system:In the system:- 1.3 million patients, 5 million 1.3 million patients, 5 million

registration entitiesregistration entities- 24 million orders24 million orders- 660 million coded results660 million coded results- 12 million dictated reports12 million dictated reports- 8.8 million radiology reports8.8 million radiology reports- 25 million prescriptions25 million prescriptions- 480,000 EKG tracings480,000 EKG tracings- 45 million radiology images45 million radiology images

Added Per Year:Added Per Year:- 600,000 ambulatory encounters600,000 ambulatory encounters- 50,000 inpatient encounters50,000 inpatient encounters

Consolidating the SilosConsolidating the Silos

ImmunizatioImmunization Registryn Registry

Electronic Electronic Medical Record Medical Record

SystemSystem

Patient ID: 123LMNOPPatient ID: 123LMNOPName: Jane Doe Name: Jane Doe DOB: 01/01/04DOB: 01/01/04SSN: N/A SSN: N/A Address: 555 Johnson RoadAddress: 555 Johnson RoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202

Patient ID: 6789XYZPatient ID: 6789XYZName: Jane Ellen DoeName: Jane Ellen DoeDOB: 01/01/04DOB: 01/01/04SSN:123-45-6789SSN:123-45-6789Address: 555 Johnson Address: 555 Johnson RoadRoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202

Global Global Patient Patient IndexIndex

Concept Concept DictionaryDictionary

Global ID:Global ID: 4567845678Name: Name: Jane Ellen Doe Jane Ellen Doe Demographics..Demographics..MRF1 ID: MRF1 ID: OU81247OU81247MRF2 ID: MRF2 ID: 45643564564356PH MRF ID: PH MRF ID: 123LMNOP123LMNOPMRF3 ID:MRF3 ID: 6789XYZ6789XYZ

Consolidating the SilosConsolidating the Silos

ImmunizatioImmunization Registryn Registry

Electronic Electronic Medical Record Medical Record

SystemSystem

Global Global Patient Patient IndexIndex

Concept Concept DictionaryDictionary

St. St. Vincent Vincent

MRFMRF

Clarian Clarian MRFMRF

Wishard Wishard MRFMRF

Community MRFCommunity MRF

Public Public Health MRFHealth MRF

Global Global Patient Patient IndexIndex

IUMG MRFIUMG MRF

Concept Concept DictionaryDictionary

The Indiana Network for Patient The Indiana Network for Patient CareCare

Record LinkageRecord Linkage DeterministicDeterministic

- ““All-or-None”All-or-None”- Rules based on exact agreement or Rules based on exact agreement or

disagreementdisagreement ProbabilisticProbabilistic

- Each identifier (Name, DOB, etc.) is associated Each identifier (Name, DOB, etc.) is associated with customized weights based on identifier with customized weights based on identifier agreement ratesagreement rates

Fuzzy MatchingFuzzy Matching- Middle groundMiddle ground- Increases flexibilityIncreases flexibility- Pragmatic approachPragmatic approach

Global Patient Registry Linkage Global Patient Registry Linkage Algorithm FeaturesAlgorithm Features

One record per assigned patient number per One record per assigned patient number per institutioninstitution

Create logical links between each of these Create logical links between each of these recordsrecords

Match using social security number, patient Match using social security number, patient name, birth date and gendername, birth date and gender

Use string comparator algorithm and phonetic Use string comparator algorithm and phonetic transformations for near name matchestransformations for near name matches

Implements the concept of a “patient group”Implements the concept of a “patient group”

Global Patient RegistryGlobal Patient Registry

AssigningAssigningAuthority Authority Global #Global # Local Pat #Local Pat # Patient NamePatient Name Birth dateBirth date

SexSex

Hospital AHospital A 99-199-1 231456231456 Sinkwell, Ralph JSinkwell, Ralph J 12-2-5912-2-59 MM

Hospital BHospital B 123-0123-0 A47239A47239 Sinkwell, RJSinkwell, RJ 2-12-592-12-59 MM

Hospital AHospital A 99-199-1 10321151032115 Sinkweil, RalphSinkweil, Ralph 12-2-5912-2-59

Hospital CHospital C 101-0101-0 A3276A3276 Fredrick, AliceFredrick, Alice 4-14-784-14-78 FF

Hospital AHospital A 101-0101-0 23145902314590 Fredrick, AlyceFredrick, Alyce 4-14-784-14-78 FF

Global ID is for internal indexing onlyGlobal ID is for internal indexing only – – not publicly exposednot publicly exposed

Results Results Retrieval: Retrieval:

Patient Patient Selection Selection

DialogDialog

Results Results Retrieval: Retrieval:

Patient Patient Selection Selection

DialogDialog

Results Results Retrieval: Retrieval:

Patient Patient Selection Selection

DialogDialog

Results Results Retrieval: Retrieval:

Global Global Patient Patient GroupGroupDisplayDisplay

Results Retrieval InterfaceResults Retrieval Interface

Thank You!Thank You!

Shaun Grannis, M.D. M.S.Shaun Grannis, M.D. M.S.

The Regenstrief Institute The Regenstrief Institute

[email protected]@regenstrief.org