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Connecticut's Department of Social Services handles about a million clients a year, contracting medical and dental services for many of them. That's a lot of people.
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To keep track of all them and try to ensure each is who they say they are and whose records say they are, the busy agency uses patient matching software from NextGate Solutions Inc.
"We want to take care of people and to take care of people you have to identify them across your programs and be able to identify the right people all the time so you're delivering the right intervention," said Minakshi Tikoo, DSS' health and human services health IT coordinator. "You want to make sure the identification of that person is not confused with somebody else."
Patient matching and identification are not only critical to Connecticut state human services provider -- enough so that the state has paid NextGate about $1.3 million for the software since it was installed in early 2015 -- but they have also become a national issue.
Legislation to mandate a national patient identification number -- similar to systems used in European countries -- has long been stalled in Congress, stifled mainly by conservative lawmakers who fear it could infringe on individual rights.
But in the last few years, nonpartisan health IT advocacy groups such as the American Health Information Management Association, the College of Healthcare Information Management Executives and others have pushed patient matching and national patient ID to some measure of visibility.
CHIME is also running a national patient identifier challenge with a $1 million prize. Four finalists -- three vendors and an individual developer -- have been chosen, with a winner expected to be announced in late 2017.
Most recently, the House Appropriations Committee asked during budget deliberations in July 2017 for a report from the U.S. Department of Health and Human services on how a patient matching system would work if Medicare required patient identification technology. The House's language emphasized patient safety, a key benefit touted by proponents of a national patient identifier.
While not the full national patient identifier framework that many in health IT have called for, the move shows that Congress appears to have more appetite for the issue than in the past.
In the meantime, Andy Aroditis, NextGate's CEO and president, said his company's patient matching software -- based on an enterprise master patient index (EMPI) platform NextGate calls MatchMatrix and first released in 2007 -- can already do much of what a national patient identifier would do.
Aroditis also questioned whether a national patient identifier would be the answer to all patient matching issues, arguing that in countries with such a system, patient matching problems still persist because of multiple and inaccurate ID numbers.
"I question whether Congress can do anything at this point. It seems like an impossible dream," Aroditis said. "But it would actually really help our technology because we would use it as additional identifier for an individual."
The EMPI correlates patient IDs across an enterprise's departments and IT systems such as EHRs, medical specialty software, integrated delivery networks and health information exchanges.
"We facilitate the interoperability of systems within the same organization," Aroditis said. "A few years ago, it was all best of breed. So [providers] went out and got a pharmacy system, or a PHR or what have you. By having all those systems, you've generated a lot of silos of information. To connect all those systems together, you need a system like ours."
Minakshi Tikoohealth and human services health IT coordinator, Connecticut Department of Social Services
To differentiate itself from other patient matching software vendors -- such as QuadraMed Affinity Corporation and InterSystems Corporation -- NextGate touts its database of some 200 million patient IDs and its long experience in the field.
The company's EMPI has roots in a more than 2-decade-old project to build a searchable database of demographic information. NextGate recently added a biometric option using machine learning-assisted facial recognition for extra accuracy, but the main system is not biometrics-based and customers have mainly been relying on the software platform.
Up to now largely on premises-based, NextGate is moving to a cloud system and plans to unveil some cloud offerings in 2017.
At the Connecticut DSS, the NextGate EMPI helps the agency make sense of the myriad patient-client identifiers floating around its far-flung systems, in which each sub-system such as medical or dental care, substance abuse or social services relies on its own identifying codes.
To create a master ID, the DSS uses 17 points of demographic data; the agency typically creates about three million unique IDs (more than its client base because new clients are coming in as others leave). Each day, the agency uses the EMPI patient matching technology to clear up about 60 duplicates -- that is when more than one client shares an ID.
"So when this data flows to us, that's when we create a unique ID, which is matched with all these numerous other IDS that are coming from all these individual streams of data we get," Tikoo said.
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