Patient Matching in the Indiana Network for Patient Care

1. Patient Matching in the Indiana Network for Patient Care Shaun Grannis, M.D. M.S. The Regenstrief Institute and Indiana University School of Medicine

2. Regenstrief Beginnings • Endowed by Sam Regenstrief - inventor of the low cost dishwasher • Obsessed with process improvement • Supported the creation of the Institute in 1972 to apply process improvement to medicine

3. Regenstrief Institute • Regenstrief tasked in 1972 to “stitch” silos of medical information together -> the Regenstrief Medical Record System (RMRS/Wishard Memorial Hospital) • In 1994, began stitching together information across institutions (INPC/Indianapolis) • In 2003, working towards stitching the state together (INPC/Indiana)

4. A “Big” Repository by US Standards • In the system: • 1.3 million patients, 5 million registration entities • 24 million orders • 660 million coded results • 12 million dictated reports • 8.8 million radiology reports • 25 million prescriptions • 480,000 EKG tracings • 45 million radiology images • Added Per Year: • 600,000 ambulatory encounters • 50,000 inpatient encounters

5. Consolidating the Silos Patient ID: 123LMNOP Name: Jane Doe DOB: 01/01/04 SSN: N/A Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Global Patient Index Immunization Registry Global ID: 45678 Name: Jane Ellen Doe Demographics.. MRF1 ID: OU81247 MRF2 ID: 4564356 PH MRF ID: 123LMNOP MRF3 ID: 6789XYZ Patient ID: 6789XYZ Name: Jane Ellen Doe DOB: 01/01/04 SSN:123-45-6789 Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Concept Dictionary Electronic Medical Record System

6. The Indiana Network for Patient Care Consolidating the Silos Clarian MRF St. Vincent MRF Global Patient Index Immunization Registry Global Patient Index Concept Dictionary Public Health MRF Wishard MRF Concept Dictionary Electronic Medical Record System Community MRF IUMG MRF

7. Record Linkage • Deterministic • “All-or-None” • Rules based on exact agreement or disagreement • Probabilistic • Each identifier (Name, DOB, etc.) is associated with customized weights based on identifier agreement rates • Fuzzy Matching • Middle ground • Increases flexibility • Pragmatic approach

8. Global Patient Registry Linkage Algorithm Features • One record per assigned patient number per institution • Create logical links between each of these records • Match using social security number, patient name, birth date and gender • Use string comparator algorithm and phonetic transformations for near name matches • Implements the concept of a “patient group”

9. Global Patient Registry Assigning Authority Global #Local Pat #Patient NameBirth dateSex Hospital A 99-1 231456 Sinkwell, Ralph J 12-2-59 M Hospital B 123-0 A47239 Sinkwell, RJ 2-12-59 M Hospital A 99-1 1032115 Sinkweil, Ralph 12-2-59 Hospital C 101-0 A3276 Fredrick, Alice 4-14-78 F Hospital A 101-0 2314590 Fredrick, Alyce 4-14-78 F Global ID is for internal indexing only – not publicly exposed

10. Results Retrieval: Patient Selection Dialog

11. Results Retrieval: Patient Selection Dialog

12. Results Retrieval: Patient Selection Dialog

13. Results Retrieval: Global Patient GroupDisplay

14. Results Retrieval Interface

15. Thank You! Shaun Grannis, M.D. M.S. The Regenstrief Institute sgrannis@regenstrief.org