Positively Identifying Patients - Arkansas HFMA...Challenge: managing digital patient identities...

10/23/2016

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©2015 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks ofExperian Information Solutions, Inc. Other product and company names mentioned herein are the trademarks of their respective owners.No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian. Experian Internal.

Positively Identifying Patients

Chris Wild

Experian Identity Management Solutions

2©2015 Experian Information Solutions, Inc. All rights reserved.Experian Internal.

Healthcare Transformation

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Current State of the IndustryA disconnected ecosystem

Healthcare lacks a universal identifier


The Affordable Care Act sought to coordinate care

and efficiency

� ACO’s do not provide a mechanism for data sharing

� Patient Identification across care settings is difficult

Current state of the industryA disconnected ecosystem: ACO

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Current state of the industryA disconnected ecosystem: HIE

Despite significant stimulus set aside as a result of the

HITECH Act:

� Health Exchanges have had difficulty with sustainability

� Does not solve competitive concerns

� Interoperability is not simple

� Most HIEs today solve only regional interoperability


Current state of the industryA disconnected enterprise

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Current State of the IndustryChallenge: managing digital patient identities

Disconnected Ecosystem

Lack of Universal Identifier

Numerous Systems

Data integration complexities

Data in Motion

Fluid, changing patient data


How does the incorrect

identification of patients

impact your organization?

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Patient care in silos

Lack of visibility &

transparency

Medical errors

High costs

The Negative ImpactsEntire Healthcare Enterprise


Preventable Medical Errors

Cost: 1,000+ lives per day

Patient Safety Implications

What is the number 3 cause of deaths in the United States?

$1Trillion each year

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� Result:

► Incorrect treatments

� Consequence:

► Potentially fatal, serious physical or emotional damage

� Secondary:

► Lawsuits

► Loss of patient trust

► Loss of patients

Patient Safety Implications

True Story:

A Minnesota patient underwent a bilateral mastectomy for cancer, only to find out post surgery a mix-up with the biopsy reports had occurred, and she had not actually had cancer.


Financial ImplicationsDuplicate record reconciliation costs

Average Hospital Size

800,000 Records

8% - 12%

Percentage of Duplicate Records

Estimated Reconciliation Cost

$50 per Pair

Estimated Hospital Cost Burden

$1.6 - 2.4 Million

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Health enterprise

Finance

Security

Compliance

Operations

Patient Engagement

Medical / Nursing

The negative impacts of incorrect patient identification across the healthcare enterprise

• Mixed PHI = HIPAA breach

• Inhibits Meaningful Use compliance

• Lessens patient trust

• Patient safety issues from incorrect treatments

• Billing errors

• Cost of redundant / unnecessary tests

• Resources spent fixing records

• Prevents information exchange

• Prevents coordination of care

• Stunts effectiveness of IT tools

• Data quality issue spread through systems


Traditional EMPI solutionsCurrent limitations

� Enterprise Unique ID (EUID) does not match across entities with separate EMPIs

� Solely dependent on client-provided patient roster and its data quality

� Potential to seed with errors (especially for date of birth and Social Security number –transpositions, default values, etc.)

� Reactive at best to changes in identity information (name, address, etc.)

Enterprise Master Patient Index (EMPI)

Does this record pertain to the same patient as any of the other records in my system?

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The Future StateSolving for a disconnected industry / ecosystem

Answers: Who is the person in my system (or not) to whom this patient record pertains?

� One unique Health Personal Identity Number (PIN) across system

� Better match rates, with strong “network effect”

� Integrity and control of reference identity data – easier to maintain and update “single best record.”


Match, Manage, and Protect Patient Identities

It all starts with understanding who your patient is

patients?

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Benefits of a Universal Patient Identifier

Patient engagement

Care coordination

Quality of care

Cost of care

Operational efficiency


� Information exchange across the

ecosystem

� Network effect benefits:

� Consistent identifier

� Patient identity accuracy

� Deeper care coordination across

other organizations

� Addresses day-to-day challenges

i.e. duplicate MRNs

� Increased value from other solutions

Benefits

The Network Effect

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©2015 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks ofExperian Information Solutions, Inc. Other product and company names mentioned herein are the trademarks of their respective owners.No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian. Experian Internal.

Protecting Digital Identities


2015 Trends

� 121.6 Million records compromised vs. 8.3 Million in 2014

� 22% annual growth fastest growing

� 20 – 50 times more valuable than financial identities

� 1 in 3 Americans affected by health data breach

The Target of ChoiceHealthcare

0

20

40

60

80

100

120

140

160

Medical / Health

Mil

lio

ns

Number of records compromised 2014 - 2016

2014

2015

2016

Source: Identity Theft Resource Center, Dec 2015 report

*2015 numbers are through 1226/16

(Projected)

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Media Attention Increases Awareness


Medical identity theft is the fastest growing

type of identity theft at 22% annually

The growing need to protect medical identitiesKey statistics

64% of patients cited privacy issues as a

key concern for accessing health information online

Medical identity theft victims pay an average of

$13,500 to resolve the theft

21% of patients withhold information from doctors out of concern of data security

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Online Patient AccessThe next wave

� More than three-fourths offer at least four ways of electronic patient engagement

Source: Office of the National Coordinator for Health IT,

ONC Data Brief 29, October 2015

� Nearly two-thirds provide opportunity to view, download and transmit

� Nearly all allow viewing health information electronically

79%

64%

91%


Digital Patient Identities Harder to Protect

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� Patient portals

� Physician portals

� Client portals

� Telehealth portals

What’s at RiskPoints of attack


Why Portals are Vulnerable?

� Lack of proper detection tools

� Information displayed without disguise / encryption

� Common methods of attack:

� Stolen PII from network breach

� Phishing emails

� Key-stroke logging Trojans

� Malware leveraging ICD-9/10 or SNOMED

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The Challenge Balance security and convenience

Security Patient Experience


Current Process is Complex and Cumbersome

Patient at home Patient visits portal to

make appointment

Portal tells patient to visit facility for code

to enroll

Patient drives to facility and requests

code from registration

Two weeks later, a code is received by

mail at patient’s home

Patient visits portal and enters code

Once entered, patient is redirected

to confirm request via link sent to email

Patient goes through email and clicks link

Patient redirected back to patient portal

to complete self-registration

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How can device intelligence be leveraged to detect fraud?

Determine friend from foe with device intelligence

Trust & Compatibility

Have we seen this device and patient together before?

Does the device configuration match a patient’s preferences

Hostile Device Behavior

Has this device been seen before impersonating identities?

Is this device frequently changing emails?

Criminal History

Is this a known fraudulent device?

Is this email address associated with fraud?


The Benefits of Identity Management and Protection

• More likely to engage• More likely to refer

Builds PatientSafety & Trust

• Correct patient demographics• Better longitudinal patient recordsImproves Data Quality

• Better opportunity for reimbursements• Reduces risk

Lowers Financial Costs

• Minimizes duplicate records• Reduces possibility of redundancy/omission

Increases Operational Efficiency

• HIPAA Compliance• Compliance with Accountable Care Measures

Achieves Regulatory Goals

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Ask Experian HealthExperts in Identity Management and Protection

� Identity Resolution

� Universal Identity Manager

� Enterprise Identity Manager

� Identity Verification

� Precise ID

� Digital Risk Score

� Fraud Prevention

� Medical Identity Alerts

� Med Detective

Experian Health


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