• Background
  Newfoundland and Labrador Centre for Health Information is Canada’s most comprehensive provincial health information centre.
• Challenge
  Find a fast, efficient way to link, share and update patient/clinic demographic information across a vast geographic area serving 530,000 people.
• Solution
  Achieve complete data sharing and standardize processes using the Initiate EMPI software and Quovadx integration technology.
• Results
  Initiate EMPI software provides the Centre, hospitals, community health offices and the provincial agencies it serves with instant access to a single demographic record for each person.

The Newfoundland and Labrador Centre for Health Information is Canada’s most comprehensive provincial health information centre and serves as an innovative model for other provincial centres. Dedicated to making quality health information available to both the public and healthcare professionals, the Centre is responsible for developing and managing a province-wide Health Information Network (HIN), which enables comprehensive and secure electronic sharing of patient information. The Centre manages data standards for the province and provides statistics and other information to support healthcare decision making, planning and research. The Centre also partners directly with the research community on applied health research, such as EHR evaluation frameworks.

The Centre serves an eight-region large geographic area with a population of 530,000. One of the mandates of the Centre is to develop a comprehensive and integrated Health Information Network for the health and community services sector. The HIN is the foundation to establish a province-wide electronic health record (EHR), which can be successful only if patient data can be shared electronically across all source systems, including healthcare facilities, the province’s health insurance plan, and the province’s community health system.

Although all hospitals in the province have Meditech, an enterprise clinical software solution, there was no method to enable patient data sharing other than traditional manual methods. Each facility had its own Meditech data repository of patient information. This information was readily available if a patient was treated, but only at that facility. If the same patient needed emergency care while traveling or after moving to another town or region, the patient’s new healthcare providers had to call and request a copy of the records from the previous place of treatment. This could take hours or longer depending on time of day and other factors. In addition, registration personnel had no way to confirm immediately whether a patient had valid health insurance coverage with the province, which could cause the facility to incur unnecessary expense if it was unknowingly paying for uninsured persons.

In order to meet requirements for certain health information technology initiatives, including the implementation of PACS (picture archiving and communications system), a province-wide drug information system, and an EHR for every patient, the Centre was challenged to link the many separate silos of patient data in Meditech. The solution was to implement a system that could cross-reference medical record numbers from multiple sources that would eventually allow for the consolidation of person-specific health information.

“The Centre needed an EMPI solution with robust methodology to identify people with multiple identifiers across many disparate sources and that would facilitate consistent client registration,” says Mike Barron, project leader of the Health Information Network at the Centre. “Such a methodology is core to achieving an accurate, patient-centric view no matter where in the province the patient presents for treatment. We also needed a solution that would not require extensive customization or complex implementation.”

In 2001, the Centre engaged QUOVADX Identity Services, an Initiate Systems business partner, to implement an enterprise master person index (EMPI), a major technology enabler for a full client registry solution. This system was known as the Unique Personal Identifier/Client Registry System. In late 2004, Quovadx, in collaboration with the provincial health registration stakeholders, migrated the Unique Personal Identifier/Client Registry to Initiate EMPI software. With Initiate software powering the provincial client registry, demographic data can now be shared (as before but with a stronger product) among nine regional Meditech systems, Newfoundland’s MCP (medical care plan, or provincial health insurance system), and the Client and Referral Management System, (CRMS) a community health system that includes a province-wide case/client referral management operation.

Quovadx also implemented its industry-leading Cloverleaf® Integration Suite interface engine to guarantee the delivery of information exchanged between the nine Meditech systems and the Initiate software. Provincial registration staff add any new patient transactions to source systems, such as name or address changes, which then automatically populates the Initiate software through the QUOVADX Cloverleaf engine. As soon as the new information is entered, Initiate software makes the updated records available to the regional Meditech systems and CRMS system across the province. In this way, the Initiate Systems EMPI supports informed patient care by providing instant access to accurate demographic information, such as name, birth date, healthcare ID number, and eligibility for provincial healthcare benefits at the point of registration.

“Initiate Systems’ EMPI allows us to share patient demographics between provincial hospitals, our public health system, and MCP system,” Barron says. “Now all of the province’s systems have accurate, up-to-date information available at all times.”

Since the Initiate software went live, the higher quality of the data has greatly improved the efficiency of the registration process at Newfoundland’s healthcare facilities. Because the Initiate Systems EMPI is seamlessly integrated, registration personnel simply use the same Meditech interface that they are familiar with, and little, if any, training is required.

According to Barron, Initiate software’s probabilistic matching functionality significantly improved registration processes, greatly enhanced accuracy in searching for patient records, and reduced instances of creating duplicate records. As opposed to deterministic matching, which looks only for exact matches to the search terms (“John Smith”), probabilistic matching provides more data to look at (“John Smith, Jon Smith, John A. Smith, John Alan Smith,” etc.) to help registration personnel determine if the correct record has been retrieved.

Demographic changes made to the patient’s record at registration populate the client registry. This information will automatically populate source systems should the patient present for services at any of the other provincial facilities. “Now everyone has the latest and most accurate information,” Barron says. “The Initiate Systems EMPI gives us a province-wide source of truth for patient demographic information that previously only existed on a regional basis.”

In addition, before the implementation of the client registry (now Initiate software), to confirm proof of insurance, registration personnel would have no way of immediately identifying patients who were eligible for MCP. In the meantime, the hospital would take the financial risk of providing treatment with no guaranteed reimbursement. Today, Initiate software enables the MCP to share insurance eligibility information instantly with the hospitals in all regions. As a result, hospitals have the opportunity to set up a payment plan at the point of registration for patients who are uninsured.

“Having a patient-centric view of data will eventually reduce redundancy in ordering tests,” Barron says. “Once the EHR is fully functional, healthcare providers across the province will be able to look at one complete patient record listing all medical procedures and tests that the patient had been given. Hospitals and patients will both save time, money and avoid inconvenience by the elimination of duplicate test ordering.”

Looking to the future, the Initiate Systems EMPI lays the foundation for several large health information and communications technologies initiatives in Newfoundland and Labrador, including integrating the client registry with a provincial drug information system and a province-wide PACS system.

“Both of these projects will bring the Centre for Health Information one step closer to achieving a province-wide EHR,” Barron says. “Then, as now, we will rely on Initiate Systems EMPI software as our province-wide source of truth for patient demographic information.”