Patient Identity and Digital Record Matching: A New Approach

March 1, 2016

Tess Coody, CEO, Tenet Health

Roderick Bell, CIO, Tenet Health

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

S

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

Why Does Identity Matter?

• Doyle Wesley Coody Jr. and Doyle Wesley Coody, III –

two people, one MRN

012345

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

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 17

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

S

T

E

P

S

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

Smart Card Alliance

info@smartcardalliance.org

800-556-6828