What’s in a Name?: Colorado’s Approach to Identity InteroperabilitySession #23, August 10, 2021

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Carrie PaykocDirector, State of Colorado Office of eHealth Innovation (OeHI)

Ako Quammie Health Information Exchange Architect, CORHIO

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

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Meet Our Speakers

Health Information Exchange Architect,CORHIO

Ako Quammie

Director of the State of Colorado’s Office of eHealth Innovation (or OeHI)

Carrie Paykoc

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Speaker Introduction

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As Colorado’s Director of the Office of eHealth Innovation (OeHI), Carrie Paykoc provides strategic leadership and coordination for health information technology, health information exchange, and data sharing statewide and across Colorado’s state health agencies. Carrie has over 15 years of healthcare experience in both not-for-profit and private organizations- in both clinical and administrative roles. Carrie holds an MBA-Health Administration, Master of Science, and Bachelor of Science from the University of Colorado at Denver.

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Conflict of Interest

Carrie Paykoc, Director of the State of Colorado’s Office of eHealth Innovation

(OeHI)

Have no real or apparent conflicts of interest to report.

Ako Quammie, Health Information Exchange Architect, CORHIO

Have no real or apparent conflicts of interest to report.

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Agenda

This session will provide an overview of:

● Problems associated with identity resolution and why it is important

● Challenges and opportunities associated with identity resolution

● How OeHI and CORHIO worked together to resolve these issues

● Key takeaways from this project and next steps

● Parting thoughts, Q&A

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Learning Objectives

• Identify objects utilized in identity resolution

• Summarize identity-resolution technology

• Identify where identity resolution was implemented

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OeHI’sMissionTo promote the expanded use of Health IT in Colorado. The Office of

eHealth Innovation will identify priorities to:

• Establish an open and transparent statewide collaborative effort to develop common policies, procedures and technology approaches that will enhance Colorado’s Health IT network.

• Promote and advance data sharing by reducing or removing barriers to effective information sharing.

• Support health innovation and transformation by enhancing Colorado’s health information infrastructure.

• Improve health in Colorado by promoting the meaningful use of Health IT.

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The Colorado Health IT Roadmap ● OeHI and eHealth Commission: SB15-008● Roadmap developed in 2018 with broad

stakeholder input from across Colorado● Significant investments in infrastructure,

innovation, and policy● Advancing Polis-Primavera Priorities● COVID-19 Exacerbated Gaps● Roadmap Refresh Started- Input Wanted!

○ Health Equity○ Public Health, Behavioral Health ○ Sustainability- End of HITECH○ Interoperability

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Colorado’s Health IT Roadmap Initiative: Uniquely Identifying an Individual Across Systems

The objective was to define current and future state, leverage existing health

information technology infrastructure when feasible, and modernize state

process and infrastructure.

Use Case 1#: Improving efficiencies and coordination across Health & Human

Services agencies

Use Case 2#: Coordinating vaccination outreach for Medicaid patients to

receive COVID-19 vaccinations

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Completed Key ActivitiesKey Phases

● Unders tand 1980s architecture and SMEs● Imagine future s ta te● Talk with experts such as HIEs , digita l health

experts , and data governance experts

1 Complete bas eline as s es s ment, define us e cas es , obtain s takeholder input

● WIC/ SNAP/ Medicaid Use Case● Low Contract $● High-Value

2 Pilot and prototype ideas for key us e cas es with HIEs and s takeholders

● HITECH funding● MES continued implementation funding

4 Finance through s ta te and federal funds

● Recruit smart & pas s ionate people● Implement with our tech partners● Data governance proces ses and tech

5 Implement and evaluate efforts

Colorado’s Approach to Identity Efforts

● eHealth Commis s ioner advis ement● Collaboration● Communication

3 Stakeholder buy-in, collaboration, and communication

Image by Office of eHealth Innovation

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Use Case #1: Current state of identity systems

Image by Wikipedia

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Use Case 1: Where we are now

Image by Office of eHealth Innovation

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Use Case #2: Immunization OutreachCOVID Vaccination Rates: 1 Dose

Image by Colorado Department of Health Care Policy & Financing

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Use Case #2: Immunization OutreachCOVID Vaccination Rates: Full Vaccination

Image by Colorado Department of Health Care Policy & Financing

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Use Case #2: Immunization OutreachMedicaid COVID-19 Vaccination Rates by Race/Ethnicity

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Age 16+ Only

Image by Colorado Department of Health Care Policy & Financing

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Consumer/Patient Centric Use Cases: Digital IDs

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Our current phase of identity efforts in Colorado

Image by Wikipedia

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Partnership with CORHIO• Former State Designated Entity• eHealth Commission advises and steers

state efforts that include HIEs such as CORHIO

• Long term partnership between OeHI, state agencies such as Medicaid and HIE

• Solution leveraged during COVID-19 pandemic and for vaccination efforts

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Image by Canva

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Speaker Introduction

Ako Quammie, Health Information Exchange

Architect at CORHIO, has over 16 years of

experience working with many segments of the

healthcare industry. He has extensive experience

implementing clinical integration programs,

electronic health record systems and quality

reporting systems focused on population-level

health improvement and development of the

capabilities required to succeed under value-

based payment arrangements.

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CORHIO’s Mission• Independent, nonprofit HIE that

serves Colorado healthcare stakeholders

• Clients include physicians, hospitals, behavioral health facilities, emergency medical services, public health, labs, imaging centers, etc.

• Merger with Health Current of Arizona will create one of the largest HIEs in the country

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Image by CORHIO

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My Role at CORHIO• Charged with leading CORHIO’s data architecture team and

lending knowledge to the design and execution to the Statewide Identity Management project

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Partnership with OeHI• CORHIO provided expertise in data

flow architecture

• Referential matching allowed the state to leverage expertise

• Prior investment in the HIE allowed for efficiency by harnessing availability of data already in place

• Patient matching stack linked identify records across multiple databases

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Image by Canva

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Statewide Identity Management Service (SWIMS) Data Flow

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Image by CORHIO

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Challenges and OpportunitiesQ. What are the risks inherent without accurate identity management?

A) Corruption of records

B) Client or patient safety

C)Data integrity

D) All of the above

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Challenges and OpportunitiesThe answer is...

D -- All of the above

(Because identity management is crucial to accurate patient care information, including testing orders and medication delivery)

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Challenges and OpportunitiesChallenges - File errors due to formatting issues, etc.

Opportunities - Vendor partners use sophisticated algorithms and rules to overcome common data errors like typos, default data values, phonetic similarities, nicknames, etc.

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Image by Canva

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Problem SolvingThe Problem - File errors due to formatting issues, etc. Processing time could take up to three and a half days and require clearing old data to meet matching standards. Working to fix errors often required manual review and reprocessing.

The Solution - CORHIO and OeHI set out to produce software for referential matching. By applying this solution, current data demonstrates that CORHIO was able to identify over 19,000 instances across five state applications were the same state ID number had been assigned to two or more people.

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Image by Canva

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Results and Findings● CORHIO developed a unique identifier for consumption to

state systems and a combined file report that captures details of the duplicate identities and unique identifiers

● Using the sophisticated technology stack and working through errors, CORHIO was able to reduce these identification errors significantly

● The challenge for replicability could be addressed through legislative and policy work

● If enough states identify this need for identity management to provide better care within their communities, identity management can become commonplace

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Image by Canva

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Next Steps/Follow-up Research● CORHIO is moving into production with the tool

● Work is expected to continue into the fall of 2021

● CORHIO will work to expand this technology stack to provide real-time client identity management and expand to more applications and agencies within the state

● CORHIO is also working to provide identity enrichment services such as race and ethnicity

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Image by Canva

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Key Takeaways● Patient data matching strategy is one of the largest unresolved issues in the safe

and secure electronic exchange of health information

● The inability to accurately match patients with their records has severe patient safety and financial implications

● Identity interoperability requires expertise in data sharing from numerous agencies and partners and a significant investment of time, resources and trial by error

● Rather than creating a duplicative technology solution, leverage the prior investment in the HIEs by harnessing the availability of data already in place

● Identity resolution technology is still in the early stages but as additional data is added into the matching process, the data is improved

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Questions and Answers

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Thank you!• Carrie Paykoc, Director of the State of Colorado’s Office of eHealth Innovation

(OeHI), Email: carrie.paykoc@state.co.us; Twitter: @CarriePaykoc; LinkedIn: carrie-yasemin-paykoc

• Ako Quammie, Health Information Exchange Architect, CORHIO, Email:

aquammie@corhio.org; Twitter: @AkoQuammie; LinkedIn: akoquammie

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