Links for 2010-09-03: Meaningful Use Certification; Allscripts and Eclipsys Merge; Single Version of the Truth

Hartford Hospital Leads Connecticut Health Information Exchange with NextGate MatchMetrix

Back in February at HIMSS, NextGate and Hartford Hospital announced a collaboration to use MatchMetrix in Hartford’s Health Information Exchange (HIE) implementation.  The implementation allows Hartford to improve patient care by uniquely identifying a patient across different visits to different locations in the Hartford healthcare system and beyond.

To share more about the challenge Hartford had and the solution NextGate was able to bring with MatchMetrix, we’ve written a case study that is now available on our Resources page.  Give it a read to learn how MatchMetrix is a cost effective solution for uniquely identifying a patient so that all their data from multiple sites can be accurately associated with them.

To learn more about NextGate can help solve your enterprise master index/EMPI or HIE needs, contact us at info@nextgate.com.

NextGate News Volume 1 Available

We published volume 1 of our newsletter, NextGate News, last week and it went out to our mailing list, but for those that didn’t get it that would like to, you can view it here.  It includes updates on our MatchMetrix 7 release, recent and future webinars, updates and testimonials from our customers, and more including an opportunity take a survey and win a gift certificate.

There is also a link to this newsletter on our Resources page on the web-site.

Should you wish to get future newsletters, you can be added to our mailing list so you don’t miss a thing.

NextGate MatchMetrix in the IHE Product Registry

Integrating the Healthcare Enterprise (IHE) organizes Connectathons on a regular basis for vendors of healthcare IT to come together to test their products to ensure they are interoperable according to the defined integration profiles.  Back in April, NextGate successfully used MatchMetrix to demonstrate Patient Identifier Cross Reference (PIX) and Patient Demographic Query (PDQ) standard interoperability across all IHE use cases.

This means that healthcare organizations using MatchMetrix can be confident that they can invoke PIX/PDQ as a means to cross-reference patient identifiers between hospitals, care sites, Health Information Exchanges (HIE), and more, as well as query a central patient information server and retrieve a patient’s demographic and visit information.

Once interoperability is demonstrated, an IHE Integration Statement may be published which is available on our IHE Compliance page or directly here.  Additionally, the IHE has created the IHE Product Registry as a way for users to search for products supporting IHE Profiles with published IHE Integration Statements.

We are pleased to announce that MatchMetrix is now in the IHE Product Registry.  There are several ways you can find us there, the easiest being to search on company NextGate, but you can also search on the ATNA, CT, PIX, or PDQ profiles within the IT-infrastructure domain and we show up there too.  Go take a look!

Announcing the MatchMetrix MDM Platform 7

Today we announced the release of MatchMetrix 7, our enterprise MDM platform and three suites built on the platform for building healthcare solutions.  The enhancements in this release make it simpler and less costly for healthcare organizations to integrate Electronic Health Record (EHR) systems or build a customized Health Information Exchange (HIE) and also allow healthcare technology providers to rapidly incorporate the MatchMetrix EMPISuite into their HIE platforms.

With this release, each of the suites is built upon the MatchMetrix MDM Platform which includes all of the core functionality required for building an enterprise index across heterogeneous systems regardless of domain.  Built by the individuals that built the first vendor independent EMPI in the mid-90’s, the platform is the result of over 16 years of experience building and implementing master index products for 100’s of customers in a variety of industries.

A sampling of the new features includes:

  • A more flexible data stewardship GUI with Data Quality Manager
  • Improved security and access control with Access Manager
  • Enhanced auditing with Enterprise Tracker and Monitor
  • Significant performance and scalability enhancements that deliver up to 10x faster response time
  • Easier configuration for enterprise-wide deployments
  • New schemas for providers and terminology in addition to persons and patients

Built on the platform are three suites, pre-defined for delivering specific healthcare solutions:

To learn more, visit the web-site or e-mail us.

Bridging the Gap between Document Imaging and an EHR

The August issue of Health Data Management magazine had an article on “Bridging the Gap” between document imaging systems and EHRs.  It is a good article highlighting the value of document imaging systems and that they aren’t going away, but that they can’t replace an electronic health record (EHR) either.

The challenge with a hybrid EHR/document imaging solution though is that you now have data about the same person in different systems and as the article notes, many document imaging systems do not work in tandem with EHR systems.  This isn’t unique to EHRs and document imaging of course, but is a common problem in healthcare with data about a given patient stored in many different systems from different providers, hospitals, or clinics.

The best way to solve this is with an Enterprise Master Patient Index, or EMPI.  An EMPI connects to or receives updates from the various systems and using probabilistic matching algorithms can automatically match records and create an index that provides a single view of all a patient’s health information.  If you are interested in learning more about an EMPI and specifically the importance of the match engine component, take a look at the Match Engine blog series we are running.  Or if you are looking for an EMPI product, take a look at the MatchMetrix EMPI Suite.

Match Engine Theory and Configuration

We started a blog series on match engines and their importance to an MDM solution last week and this is our first entry taking a deeper dive into each area.  First up, match engine theory to understand what must be configured.

Right up front, thanks go to Dan Cidon, NextGate’s CTO, for the background and technical details that went into this post.

To understand how to configure a match engine, it is first useful to consider some of the types of challenges it will encounter in matching fields in records from different systems.  Some common ones include:

  • Spelling errors
  • Transpositions in IDs/SSNs
  • Aliases, i.e. Jon and Jonathan being a match
  • Transpositions of given/family name
  • Properly handling twins/triplets/etc.
  • Transpositions in or fat-fingered dates
  • Default and/or anonymous data, i.e. John or Jane Doe, an SSN of 999-99-9999, etc.

Clearly, a simple “equals” match is not going to suffice.  The approach most every match engine takes, NextGate’s included, is to compute a score indicating the likelihood of a match based on comparing selected fields using industry standard comparison functions and weighting for each comparison.  This score can then be tested against configured thresholds to determine if two records match, don’t match, or may match.  It is the configuration of the comparison functions and determination of the appropriate weights that are core to the configuration of the match engine and determining how well it will perform.

The following figure shows three example comparisons and the resulting scores and whether the records are determined to match.

ngs_scores

So how were these scores arrived at?  To understand that, we have to delve into match theory a bit.

The total score is the sum of the agreement weights  and disagreements weights for each field comparison.  Each field’s weight depends on how well the fields compare to each other, the Yes and No cases from above shown in the two figures below.

yes_weightsYes case no_weightsNo case

The weights in the figures should be fairly intuitive to a human looking at it, but it is getting the match engine to arrive at this “intuitive” result automatically that is the magic.

So how are the weights arrived at?  Each fields agreement/disagreement weight is determined from the likelihood that two fields from a population of matched records are the same or that the two fields from a population of unmatched records are the same.  From these probabilities, the agreement and disagreements weights can be computed.

For agreement weight:

  1. If the field contents of two records are identical then they are given an agreement weight defined for that field.
  2. The agreement weight is based on how likely the fields are identical based on random chance.
  3. The more likely a random identical match, the lower the agreement weight.

For disagreement weight:

  1. If the field contents of two records do not match identically then they are given a disagreement weight for that field.
  2. The disagreement weight is based on the reliability of that field. Reliability is the likelihood that the field contents of two records from the matched set are identical.
  3. The more reliable a field, the stronger (more negative) the disagreement weight.

Now, how are fields compared to determine if they are identical?

In some cases, it is pretty black and white, for example with genders where there are two possible values.  But when dealing with names, dates, addresses, etc. it isn’t, i.e. two records with a first name of John and Jon are not identical but it wouldn’t be appropriate to assign a complete disagreement weight.  This is where comparison functions come in.

Comparison functions return a value between 0 and 1 indicating how well two fields compare to each other, a 1 indicating complete agreement and 0 complete disagreement with partial agreement falling in between.  There are a host of functions used for different purposes from performing phonetic comparisons to handling transpositions to many many more.  It is the selection and configuration of the appropriate function that is critical to match engine performance.

The result of the comparison function must then transformed into a weight that ranges from the complete disagreement to complete agreement weight for that field.  One could simply do this linearly, but research has shown that piecewise linear functions where the weight drops off more rapidly as the comparison function result goes farther below 1 perform much better.  A graphical example of such similarity to weight mapping is shown in the figure below.

similarity_weight

But it isn’t enough to just have comparison functions for individual fields.  Sometimes, as is the case with multiple fields that make up a name, a comparison has to look at multiple fields or look at individual tokens of a field as if they were fields themselves.

For example, record A may store a person’s name as “John J Smith” and record B may store a person’s name as “Smith John Jason”.  Transpositions of name elements like this are a common source of data entry errors and something a match engine must deal with.

A multi-token match function compares all possible combinations of tokens between the record pairs and selects the highest weighted pairs when calculating an overall weight.  For the records above, the token comparisons that would be performed are shown in the table below (sorted by weight).

Token from Record A Token from Record B Comparison Weight
Smith Smith +6.1
John John +5.7
J Jason +4.0
J John +4.0
John Jason -6.0
J Smith -8.0
Smith John -8.0
Smith Jason -8.0
John Smith -8.0

The multi-token match function adds up all the weights, or can be configured to add the first N weights, to arrive at the weight used in the scoring.  For names with three components N would typically be 3 meaning the weight for this example would be 6.1+5.7+4.0=15.8.

This is just a sampling of how a match engine works and what is required to understand to configure it.  In future posts we’ll go into more detail and explore the other areas mentioned in the overview earlier.

The Importance of a Match Engine in your MDM Strategy

I came across an article, The What, Why and How of Master Data Management, that gives a good overview of what master data is, why it is important, what master data management is, and what it entails.

There is quite a lot that fits under the umbrella of MDM, but a key part of it is the matching of records from different systems, or new/updated records entering the system.  From the article:

Generate and test the master data: This step is where you use the tools you have developed or purchased to merge your source data into your master-data list. This is often an iterative process requiring tinkering with rules and settings to get the matching right. This process also requires a lot of manual inspection to ensure that the results are correct and meet the requirements established for the project. No tool will get the matching done correctly 100 percent of the time, so you will have to weigh the consequences of false matches versus missed matches to determine how to configure the matching tools. False matches can lead to customer dissatisfaction, if bills are inaccurate or the wrong person is arrested. Too many missed matches make the master data less useful, because you are not getting the benefits you invested in MDM to get.

Also:

Implement the maintenance processes: As we stated earlier, any MDM implementation must incorporate tools, processes, and people to maintain the quality of the data. All data must have a data steward who is responsible for ensuring the quality of the master data. The data steward is normally a business person who has knowledge of the data, can recognize incorrect data, and has the knowledge and authority to correct the issues. The MDM infrastructure should include tools that help the data steward recognize issues and simplify corrections. A good data-stewardship tool should point out questionable matches that were made, customers with different names and customer numbers that live at the same address, for example. The steward might also want to review items that were added as new, because the match criteria were close but below the threshold. It is important for the data steward to see the history of changes made to the data by the MDM systems, to isolate the source of errors and undo incorrect changes. Maintenance also includes the processes to pull changes and additions into the MDM system, and to distribute the cleansed data to the required places.

The article also describes cardinality, or the number of entities, as being an important criterion in deciding when to use an MDM solution.  A data set with “thousands of customers” is described as being a large data set and there are many MDM solutions that can handle this volume.  What separates the truly scalable solutions is how they deal with problem domains that are much larger.  For example, customer databases with tens of millions of records require very efficient algorithms not only for speed, but also to minimize the manual data stewardship required for such data sets.

Clearly, the match engine that the selected tool provides is critical to the performance and ROI of the solution.

So what are key features of a match engine?  At a high level they are:

  • Configurability – A match engine is useful only if it can be configured and tuned for the application at hand.
  • Integration – A match engine must be able to integrate with other systems to receive records and propagate changes/updates back to the systems.
  • Data Governance – A user interface and tools must be provided for comparing, merging, editing, and tracking the records.
  • Security / Auditing – Securing access to the data with role-based access controls as well as a complete audit trail of access is critical.
  • Accuracy – The whole point of a match engine is to automatically match the appropriate records so as to the number of records a human has to match manually.
  • Performance / Scalability – Initial load performance as well as ongoing performance is important, especially as the volume of data grows.
  • Reporting – Getting reports on match engine performance and data quality metrics can be very valuable.
  • Extensibility – The ability to extend backend functionality for specific domains or customize the user interface is often required.

In future entries on this blog, we’ll explore each of the above in much more detail. Stay tuned!

Indian Health Service and HHS to use NextGate MatchMetrix EMPI

The Indian Health Service (IHS) is in the midst of upgrading their Electronic Health Record (EHR) and related systems to conform to new regulations for meaningful use of EHRs.  Also as noted in that article, they are working to support requirements for health data exchange, including exchange with the U.S. Department of Health and Human Services (HHS) NHIN as well as to support a Master Person Index (MPI).

What is interesting about working with the U.S. Government is that certain contract information is public record, and this RFQ outlines how HHS intends to award a purchase order for MatchMetrix to NextGate to help build their exchange with NHIN and manage the MPI.  From that RFQ:

“Only the brand name specified will meet the Government’s need.  …  HHS intends to purchase a software license from NextGate Solutions to assist in the implementation of the Nationwide Health Information Network (NHIN) and to manage the Master Person Index (MPI) with a browser based interface.  These projects will help IHS modernize and extend electronic health information technology to improve access, quality, safety, and overall health status of American Indians and Alaskan Natives.  The NextGate software license will provide the management tools to help IHS achieve compliance with mandated federal requirements, including the HITECH (Health Information Technology for Economic and Clinical Health) Act, the AHIC-Interoperable Nationwide Health Exchange, the Federal Healthcare Architecture, and the HSPD12-HHS Identity associated with evolving criteria for Meaningful Use Electronic Health Record Certification provisions.”

The RFQ goes on to highlight the reasons for selecting NextGate which include:

  • NextGate has adapted a functional core component of NHIN CONNECT.
  • IHS has a unique environment and NextGate is already developing the schema for IHS’ MPI project.
  • NextGate is already working with IHS on other NHIN and MPI related projects including NHIN Health Information Exchange (HIE) and the Personal Health Record (PHR).
  • NextGate has comprehensive knowledge of IHS’s Resource and Patient Management System and has already developed messaging capabilities between it and NHIN, MPI, and IHS’ PHR.

And it was great to see that the contract was officially awarded late last week.

NextGate is excited to be a part of this project that will enable the IHS to deliver improved and more cost effective patient care to their members.

Final Meaningful Use Criteria and your EMPI

Meaningful Use has been a hot topic in the healthcare industry recently and after a long wait and deliberation, the Office of the National Coordinator for Health IT (ONC), together with the Centers for Medicare and Medicaid Services (CMS) released the final rules for Meaningful Use earlier this week.

The goals of Meaningful Use, at least for this first stage, are to provide incentives for healthcare providers to convert from their paper based medical records to electronic health records (EHRs).  This is accomplished through establishing rules for what constitutes meaningful use of an EHR system and then providing incentive payments to those organizations that implement an EHR system meeting the rules.

As of July 13th, we now know the rules and they aren’t an all or nothing proposition.  Instead, there are 15 “core” rules that must be implemented, and then 10 other optional or “a la carte” rules of which 5 must be implemented as part of stage 1, with the remaining required for stage 2 (2013).

The 15 core rules, extracted from a nice summary from the New England Journal of Medicine, are:

  1. Record patient demographics (sex, race, ethnicity, date of birth,
    preferred language, and in the case of hospitals, date and preliminary
    cause of death in the event of mortality) at least 50% of the time
  2. Record vital signs and chart changes (height, weight, blood pressure,
    body-mass index, growth charts for children) at least 50% of the time
  3. Maintain up-to-date problem list of current and active diagnoses at least 80% of the time
  4. Maintain active medication lists at least 80% of the time
  5. Maintain active medication allergy lists at least 80% of the time
  6. Record smoking status for patients 13 years of age or older at least 50% of the time
  7. Provide patients with a clinical summary for each office visit within 3 business days, at least 50% of the time
  8. On request, provide patients with an electronic copy of their health information (including test results, problem lists, meds lists, allergies) within 3 business days, at least 50% of the time
  9. Generate electronic prescriptions at least 40% of the time
  10. Use Computerized Physician Order Entry (CPOE) for medication orders at least 30% of the time
  11. Implement drug-drug and drug-allergy interaction checks
  12. Be able to exchange key clinical information among providers by performing at least one test of the EHR’s ability to do this
  13. Implement one clinical decision support rule, and ability to track compliance with the rule
  14. Implement systems that protect privacy and security of patient data in the EHR, by conducting or reviewing a security risk analysis, and taking corrective step if needed
  15. Report clinical quality measures to CMS or states

The optional 10 rules of which 5 must be demonstrated are:

  1. Implement drug-formulary checking
  2. Incorporate lab test data into the EHR as structured data
  3. Generate lists of patients by specific conditions to use for quality
    improvement, reduction of disparities, research, or outreach
  4. Use EHR technology to identify patient-specific education resources, and provide those to the patient as appropriate – and do this at least 10% of the time
  5. Provide medication reconciliation between care settings, at least 50% of the time
  6. Provide summary of care record for patients transferred to another provider or setting, at least 50% of the time
  7. Submit electronic immunization data to local registries (performing at least one test of data submission, where registries can accept them)
  8. Submit electronic syndromic surveillance to public health agencies (perform at least one test, where local agencies can accept them)
  9. Medical Professionals: Send reminders to patients (per patient preference) for preventive and follow-up care, at least 20% of the time, or for over-65 year-olds or under=5 year-olds)
  10. Medical Professionals: Provide patients with timely electronic access to their health information, at least 10% of the time
  11. Hospitals: Record advance directives for patients 65 years of age or older at least 50% of the time
  12. Hospitals: Submit of electronic data on reportable laboratory results to public health agencies

The challenge with many EHR systems is that they are implemented for a single provider or hospital, but patients visit many different doctors and hospitals, and thus an individual EHR can’t provide a complete view of the patient.

A solution to this is to implement or be part of an HIE that implements an Enterprise Master Patient Index or EMPI.  An EMPI helps provide a single view of a patient giving a complete view which can help provide better patient care and help implement the Meaningful Use rules.

The rules that could benefit in some way from an EMPI are bolded in the lists above and we can expect that rules in future stages of initiative will further benefit from or require an EMPI to be easily or effectively implemented.  Whether it is avoiding re-entry of information, being able to safely prescribe the right medicines, avoiding unnecessary duplicate tests, or being able to provide patients with a complete copy of their health information, an EMPI can help.

So if you are a hospital or professional looking to implement the meaningful use rules, make sure you consider the benefits of an EMPI and include one in your plans.  If you are an EHR provider or building an HIE solution, you should consider bundling an EMPI or EMPI capabilities in your offering.  In both cases, NextGate can help with the MatchMetrix EMPI Suite, contact us to learn how.