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Patient Matching
Process
• Reviewed secondary (e.g. white papers) and primary literature on patient matching
• Series of teleconferences to establish scope, develop a framework and populate the framework
Assumptions
• There are multiple use cases with different trade-offs for sensitivity and specificity – our Summer Camp focus on patient care use case
• Establishing acceptable false positive rates is a policy and perhaps local decision based on what is possible/available in a market
• Focused on guidance around the EHR
Finding/Caveats
• The data necessary to provide explicit guidance on which patient attributes to “require” or for which to improve quality
• Some patient attributes (e.g.
e-mail or zip code) vary
significantly over time
Principles
• Specificity more critical than sensitivity – false positive rate will be critical
• Don’t preclude new attributes from being added to matching process
Flow Chart
QuerySource*
Query Responder*
Query Message• Core attributes• Optional attributes
Query Response Message• Matched patients• Match metadata
Captures and ensures quality of
data needed to create query
message
Characterizes population of patients being
matched
* Note that an EMR may serve as both or either a query source and a query responder
Matching Fields
• Core– Name (last, first, middle initial)– Birth date– Gender (administrative?)
• Menu (some required to successfully match)– Address including zip (current and past)– Social security number– Maiden name– Full middle name– Healthcare provider (individual or institutional)– Visit information– Allow other assigned identifiers to support evolution
Data Quality
• Rational– Garbage-in Garbage-out– Align efforts to improve data with the importance of the data for
matching (optimize value)• Quality “assurance”
– Consistent method to identify missing/unavailable data, approximate values or questionable values
– Apply edits on a field by field basis• Valid dates• No future dates• No SS# sub-fields with all 0s or all 9s• Check that zip code is consistent with street address
– Apply edits on a cross-field basis• Check whether first name and gender are concordant
Data Formats / Content
• Build from IHE PDQ and XCDP(?) implementation guides– Expand on guidance for name structures especially Hispanic
and Asian names– Add option to provide dates along with time variant data (e.g. zip
codes, telephone numbers)
Match Quality Reporting
• What is reasonable to return with the matched patients?– Confidence level– Commonly occurring identifier flag
References
• Perspectives on Patient Matching: Approaches, Findings, and Challenges
• http://www.himss.org/content/files/PrivacySecurity/PIIWhitePaper.pdf
• http://www.ihe.net/Technical_Framework/upload/IHE_ITI_Patient_Demo_Query_2004_08-15.pdf
• http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_Supplement_XCPD_PC_2009-08-10.pdf