Rationale for the Policy
The prime reason to implement PIM strategies considers the linkage and quantity of electronic healthcare data. Currently, approximately three out of four office-based physicians in the United States use some form of electronic health records (EHR), and this number is growing rapidly due to relevant incentive programs (Gliklich et al., 2017). “Moreover, electronic health care data may be created by hospital EHRs, billing systems, insurance claims systems, pharmacy record systems, medical devices, and even by patients themselves” (Gliklich et al., 2017). This surge in EHR quantity creates a subsequent need for data linkage, as companies look for optimization of their information systems and minimization of the burden of data entry. In this framework, PIM is used to facilitate the linkage and structuring of data, increase the efficiency and effectiveness of the process, and ensure compliance with the relevant rules and laws.
Definition
A master patient index (MPI) is a database that facilitates identifying and connecting patients’ clinical information within healthcare organizations. An enterprise master patient index (EMPI) is an information infrastructure that does not serve only one organization but consolidates and links data from multiple. MPIs and EMPIs assign unique patient identifiers (UPIs) to patients within particular healthcare systems and utilize a patient matching algorithm so that the patient’s records can be accessed and tracked across multiple systems.
Policy
The process of application of MPI to manage patients’ digital records can have three phases and three main actors. The actors are the Patient Identity Cross-reference Manager, the Patient Identity Source, and The Patient Identifier Cross-reference Consumer (Integrating the Healthcare Enterprise, 2011). There may be numerous Patient Identity Sources which are the databases that provide patient identity information. The bigger is the number of sources, the more diverse is the information. This can include the patient’s illness history, recommendations from previous healthcare professionals, pharmacy records, and other valuable data that makes it easier to build a complete picture of the patient’s health status. This can allow for higher levels of autonomy of healthcare professionals working with the patient and higher efficiency and speed of all procedures.
The Patient Identity Sources sends the relevant data to the Patient Identity Cross-reference Manager, which is a system that identifies, associates, links, and exchanges the data from multiple sources. This is done using patient-matching algorithms that compare the patient’s demographic data within different databases. There are numerous varieties of such algorithms with varying thresholds of agreement, sensitivity, and accuracy; however, in most cases, these parameters can be controlled manually. After finishing its procedures, the Manager sends the data to the Patient Identifier Cross-reference Consumer if requested. The Consumer, in that case, is a healthcare organization or a specific department within that organization that needs the data on its patient.
General Guidelines
The following guidelines for a daily practice involving the patient digital records identity management can be helpful. Firstly, the data for all patients treated in the healthcare organization is to be retrieved via EMPI. In some cases, it is intuitive, for instance, when the emergency brings a patient, and the patient cannot communicate any information properly. It may seem less critical in other cases, but it should be performed as well, as some patients do not have complete information about their health, prescriptions, and recommendations. Secondly, the necessary procedures are to be performed in accordance with the recommendations from the EMPI. Thirdly, all relevant data, such as the performed procedures, advice, and prescriptions, must be included in the patient’s digital records within the EMPI, which will ease the processes next time.
References
Gliklich, R.E., Dreyer, N.A., & Leavy, M.B. (Eds.). (2017). Managing patient identity across data sources. Registries for evaluating patient outcomes: A user’s guide (3rd ed.). Agency for Healthcare Research and Quality (US).
Integrating the Healthcare Enterprise. (2011). IHE IT infrastructure (ITI) technical framework. IHE International, Inc.