Patient identity: The keystone that many strategic initiatives don’t realize is required — until it’s too late

With digital transformation efforts in healthcare being front and center, healthcare teams are focusing on how to further improve the consumer experience and connect digital touchpoints in a meaningful and interpretable way. On the surface, the concept of consumer experience is warm and fuzzy, yet getting the consumer experience right demands a personal touch, particularly in healthcare. Positive consumer or patient experiences are tied to referrals, reimbursement, health equity, and loyalty.

From the consumer’s perspective their experience starts with a simple question: How well do you know me?

The question’s simplicity belies the complexity of how healthcare leaders arrive at the answer. Confronted with a tsunami of data and a myriad of disconnected applications in which consumer data is generated and stored — think electronic health record (EHR), customer relationship management (CRM), telehealth, remote patient monitoring, and even wearables and fitness trackers — how well do you really know me? is an increasingly difficult question to answer.

For example, if the data in your EHR shows a record as:

  • Smith, Richard, birthdate of 31_Aug_1987, and phone number (213) 555-1917

And your CRM shows a record as:

  • Rich K. Smith, birthdate of 08/30/1997, and phone number (213) 555-1916

Are the two records referring to the same person? Or are there two Richard Smiths with similar birthdays and phone numbers?

Getting the answer wrong is a burden for the care team. For the patient, it’s inconvenient and costly at best. Not knowing patients well can be life-threatening at worst.

Inaccurate person identification introduces inefficiencies, billing errors, and data gaps that create clinical or legal risk. Accurate person data ensures that life-saving information appears every time a clinician views a person’s health record. It is also critical to billing accuracy and well you recruit and communicate with your consumers. In aggregate, person identity data helps inform some of the most important initiatives your organization undertakes, including digital front door, patient engagement initiatives, value-based analytics, and population health equity.

Solutions for reconciling consumer identity across multiple systems

To create a unified view of each person or population, healthcare teams first need to access and exchange electronic data. This often happens via an integration engine.

From this point forward, teams may overlook other challenges associated with confidently connecting the shared data. Independent applications lack the ability to confidently define whom each data element is associated with, especially when those data originate in another source.

For this important identity job, healthcare organizations tend to outsource to the EHR. Unfortunately, this solution misses the mark because the EHR is its own silo. To support these types of enterprise initiatives, a specialized identity data management layer or enterprise master person index (EMPI) is required. An identity management layer supports confident identification within the primary EHR as well as between the EHR and other downstream applications like the CRM, acquired ambulatory EHRs, and data analytics.

An April 2022 Gartner report describes EMPIs as “crucial tools for reconciling patient identity and addressing medical record matching challenges needed for high-quality healthcare delivery and health information exchange.”

While it’s tempting to rely on the EHR, that’s not a reliable path. One reason is that the average health system has 18 disparate EHR vendors in use across all affiliated providers, according to HIMSS Analytics. Plus, more data exists outside the EHR.

“By 2023, 35% of healthcare delivery organizations will have shifted workflows outside the EHR to deliver better digital experiences,” according to a November 2020 Gartner report..

An EMPI enables positive identification of each person’s data — and connects each person’s history — at the point of encounter, for a better patient experience, and ultimately the delivery of better-informed care. It achieves this by creating a single best record across the healthcare ecosystem.

Let’s consider the role of the consumer and their identity in several strategic initiatives:

The role of patient identity in value-based care

One strong indicator of success in a value-based care program is the consumer’s perception of the care. For instance, hospitals and specialty-specific providers being reimbursed through value-based care payment models are subject to Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, described as “the gold standard in patient engagement and satisfaction measurement.” The surveys include questions on topics such as communication, prescription medication use, care received, and ease of scheduling.

Many of the quality measures included on CAHPS surveys require an accurate view of the people you’re serving.

An EMPI helps ensure each patient’s entire care history is connected across multiple trading partners or applications. For example, with a complete, unified understanding, care providers are better equipped to improve:

  • Patient experience by reducing or eliminating duplicate test orders (e.g., imaging) that may occur because one provider is unaware of what care another provider might have provided for the patient
  • Outcomes through gained visibility into previous care provided — and outcomes achieved — by the patient’s other providers
  • CAHPS scores and therefore reimbursement

The role of patient identity in meeting consumer expectations

Consumers sit in the digital driver’s seat for virtually every aspect of their lives and are increasingly making decisions related to their health and wellbeing in this same way. As is the case with merchants, consumers increasingly expect healthcare teams to know them well, have reliable access to their treatment history, and market to them in personalized ways. Failure to meet these expectations erodes trust and pushes consumers elsewhere.

A shared identity management solution acts as a backbone for every transactional and analytical application in support of a smoother experience across every encounter. This helps build the trust required for patient engagement and reduces the clinician burden created by hunting, pecking, and comparing electronic data. This is especially true as patients increasingly interact across digital and brick and mortar touchpoints.

“Gen Z, often called ‘Zoomers,’ are stereotyped as the ‘tech-addicted’ generation,” according to Gen Z consumer research firm Knit. “But they actually prefer convenient in-person healthcare within the four walls of brick and mortar,” the study’s authors noted. “Gen Z has created a multi-channel ecosystem to source information and data related to their health without necessarily needing to see a provider.”

Patients aren’t the only ones driving toward consumer-mediated healthcare. Federal guidelines are impacting the way in which data is handled, ensuring that a person’s health data belongs to that person and that they have access to it on their terms.

The 21st Century Cures Act and resulting patient access and anti-information-blocking rules are intentionally designed to empower consumers to access their health data electronically through the app of their choosing. If the data is inaccurate or not actually their data, it hurts patient trust and could constitute a data breach by exposing the wrong personally identifiable information (PII).

The role of patient identity in delivering more equitable healthcare

To deliver more equitable care, healthcare organizations must understand how patients and populations are affected by social, economic, and environmental determinants of care. This requires accurate and up-to-date data on patient needs and preferences — Do they have reliable transportation for in-person doctor appointments? What is their preferred language? — to increase engagement and personalized care.

From a population perspective, an EMPI helps organizations confidently understand, by reconciling identities, a population in a given ZIP code which can, for example, help distribute vaccines equitably. As another example, having an accurate view of how many people reside in a particular area can help guide decisions on where to open a new clinic.

Combining EHR data with standardized data about socioeconomic needs helps healthcare organizations develop more comprehensive and detailed portraits about their patients’ holistic health status. By linking this information, teams can develop condition-specific registries to guide outreach activities, target care management strategies, close gaps in care, and connect individuals with the resources they need to stay healthy.

Although these market forces are challenging, a common denominator in meeting them is confident person identity.

EMPI technology is paving the future of interconnected healthcare networks. When you don’t know your patients well, you risk compromising their care, trust, and business. There is limited capability to address health equity and effectively adopt value-based care models if an organization does not prioritize identity management.

Knowing your people well and enabling them to connect without barriers requires you to think beyond the EHR and invest in a pragmatic data management foundation that ensures data is where you need it, when you need it, in a way that says, “Hello, we’re glad to see you again.”

Photo: invincible_bulldog, Getty Images

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