Patient Identity and Digital Record Matching: A New Approach

March 1, 2016

Tess Coody

Roderick Bell

Conflict of Interest Tess Coody-Anders, CEO, and Roderick Bell, CIO have no real or apparent conflicts of interest to report.

Agenda 1. The Topic: An identity-centric, credential-based approach 2. Method of Analysis 3. The Problem: Mismatching, misidentification and fraud 4. Impact on Healthcare 5. Recommendations

Learning Objectives • Learning Objective 1: Identify the negative impacts of the current

misidentification and mismatching problems in healthcare, such as poor patient care, inconvenience for patients and providers, and lack of patient safety

• Learning Objective 2: Evaluate the use of strong credentials for fraud reduction based on their ability to strengthen transaction processing and eliminate vulnerabilities in the healthcare payments system

Learning Objectives • Learning Objective 3: Initiate change in the way the U.S.

healthcare system identifies patients and manages care by implementing an identity-centric, credential-based patient matching and identity management model

• Learning Objective 4: Summarize the methods and solutions that the healthcare provider in the session used to address their identity management issues

• Learning Objective 5: Appraise the success of the implementation case study detailed in the session and the extent to which identity management challenges were overcome

http://www.himss.org/ValueSuite

Satisfaction: The identity-centric, credential-based model is more convenient for patients, simplifies admissions, reduces the risk of errors, and saves patients time and money by avoiding redundant tests and exams

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T Treatment: Improved patient identification will reduce redundant tests and adverse events caused by misidentification

E Electronic Information/Data: Improved patient identification will reduce redundant tests and adverse events caused by misidentification

P Prevention and Patient Education: Smart credentials can provide simplified and more secure access to patient records, increasing engagement by patients

S Savings: Smart credentials can help health care organizations save billions lost each year due to fraud and medical identity theft

Saving Lives and Money: Interoperable, Digital Identity • Identity-centric focuses healthcare systems and

processes around the accurate, reliable and repeatable identification of the patient’s identity

• Credential-based means that a trusted digital device, most likely an identity card or smart phone is used by the customer to verify his or her identity to healthcare providers

Creating an Interoperable Digital Identity System

Deterministic Interoperable

ID Tokens

Source: LifeMed ID

Method Analysis

• Cross-Industry Collaboration – Six years of analysis by collaborative of payers, healthcare

and technology providers through Smart Card Alliance • Compare and Contrast

– Healthcare versus Financial Services, Federal Government best practices

• Insights from Workgroups – WEDI, Identity Ecosystem Steering Group, HIMSS Identity

Management

Why Does Identity Matter?

• Doyle Wesley Coody Jr. and Doyle Wesley Coody, III – two people, one MRN

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The Problem

• Awareness of the scope and scale of problem

• Technology and functional silos across disparate systems

• Wait-and-see attitudes

• Noisy healthcare environment with many priorities

Impact on Healthcare: Patient Safety

• 12 percent of U.S. health records mismatched1

• 19 percent of CIOs report adverse events resulting from misidentification2

• 198K deaths annually (2010)3

• 10 out of 17 deaths due to “wrong patient” errors4

S T E P S

Sources 1. & 2. According to Michelle O’Connor, director identity and information governance, QuadraMed 3. & 4. Death Statistics, according to the IOM

Impact on Healthcare: Fraud

One SSN on the Black Market:

$0.43

One healthcare record on the Black Market:

$50 S T E P S

Impact on Healthcare: Fraud and Waste

• $77 billion in Medicare/Medicaid fraud and improper payments

• $13,450 out of pocket costs to victims

• Duplicate records cost average hospital $500k to $2.5M

Source: Medical Identity Fraud Alliance (MIFA), 2014

S S T E P S

Impact on Healthcare: Patients

• 45 percent of victims said the incidents damaged their reputation

• 19 percent said it cost them career opportunities

• 3 percent said it actually caused them to lose their jobs

Source: Medical Identity Fraud Alliance (MIFA), 2014

S T E P S

Impact on Healthcare: Patient Experience and Education

• Automated registration experience

• Increased privacy and safety

• Assurance that their doctor is accessing their correct information

• Prevents redundant paperwork and testing

• Easy auto pay

• Easy access to personal medical record

S T E P S

Breaking Down the Silos

Automate Workflow using Provider’s Current Software

Validate Patient, Token Photo, PIN, Biometric

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Medicare, Medicaid, CHIP, Debit, HSA Patient ID and Data

Exchange Portal™

Bridging EMS with Patient Data and ER

Source: LifeMed ID

Big Data & Analytics

Home Health

Government Payers- Insurance

Hospital

Clinic/Physician

Education

Interoperable ID Tokens and Data Shared Between

Disparate Groups

Financial iServices

iRetail

Smarter Retail

Smarter & Safer

Healthcare

Smarter & Safer Cities

Social Business

First Responders

Smarter Communities

Source: LifeMed ID and IBM

http://www.himss.org/ValueSuite

The industry is ready, now

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E

P

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The utilization of a unique identifier is realized in all subject matters within STEPS™. Operational and clinical change starts with: 1. Positive patient identification 2. Accurate record matching 3. Workflow automation

Case study: Avg. admission time was reduced from 4 minutes to less than 1 minute

Assures a minimum accomplishment of an LOA of 3

Case study: Reduced duplicate errors from 7% to less than 1%

White paper: Enabled the hospital to work with community and local retailers to help change overall health

The operating budget impacted by utilizing authoritative digital identity: $1,837,917.33

Questions? Tess Coody-Anders tcoody@mywellvana.com 210-884-8060 Roderick Bell rbell@tenntx.com 505-659-8947