Initiate software battles data integrity ills with automated patient identity management

• Background
  Sentara Healthcare is a premier East Coast not-for-profit healthcare provider with more than 70 care sites, offering a full range of healthcare services and coverage.
• Challenge
  Implement an enterprise master person index (EMPI) solution to reduce duplication rates and seamlessly integrate 4.2 million records across hospitals and clinics.
• Solution
  Deploy Initiate software to proactively manage patient identities within the healthcare system.
• Results
  Information is easily shared throughout the system, increasing physician satisfaction and patient safety, while dramatically reducing duplicates.

Sentara Healthcare is the largest integrated healthcare provider in southeastern Virginia and northeastern North Carolina. Serving more than 2 million residents, Sentara operates 6 acute care hospitals: Sentara Norfolk General, Sentara Leigh, Sentara Virginia Beach, Sentara Bayside, Sentara CarePlex and Sentara Williamsburg Community Hospitals; and one extended stay hospital, Hospital for Extended Recovery. Operating more than 70 sites of care, Sentara Healthcare includes 25 primary care practices, a full range of health coverage plans, home health and hospice services, physical therapy and rehabilitation services, urgent care facilities, ground medical transport services, mobile diagnostic vans and two health and fitness facilities.

Sentara Healthcare has a medical group with 220 participating physicians and more than 15,000 employees. They have been recognized by the Wellness Councils of America (WELCOA) with a Gold Well Workplace Award for programs that demonstrate a sincere commitment to wellness in the workplace and improving employee health.

In the mid 90’s, Sentara Healthcare was already ahead of most integrated healthcare networks. They were in the process of implementing a physician-facing product that would help give their physicians complete access to their health system’s patient records. Initially, Sentara believed this new system would help put their physicians in better touch with their patients, but as time went on, they realized the new system had a few drawbacks. Because patient data information was spread across, at that time, five different hospitals, it was difficult for the registrars to easily find patient records, so often it was quicker to create new ones. With all the patient records that were being created, physicians were now complaining that they could not gather all the information they needed on any given person and could not be certain if patient information was missing. Sentara tried to make enhancements to their system to correct the problem, but in the end, they just could not break the barrier of massive duplication.

Sentara knew they needed to boost physician satisfaction and increase patient safety, so in early 2002, Sentara decided to try again to get their duplication creation rate under control. They decided to implement an Enterprise Master Person Index (EMPI), a specialized form of master data management, which would help them more effectively manage their patient identity data by streamlining records so they could get a better, more accurate view of their patients. Implementing an EMPI not only would help their integrated healthcare network solve their integration and duplication issues, but it would also help them meet upcoming Health Insurance Portability and Accountability Act (HIPAA) requirements and would pave the way to enable them to support an electronic medical record (EMR) in the near future.

Sentara knew they needed to find a vendor who would help them accomplish the task of implementing an EMPI solution. After extensive research, Sentara narrowed down the list to a few key vendors. After sending out requests for information, Sentara evaluated the responses, narrowed the list even further and conducted more detailed reference calls and in-depth discussions with the remaining candidates. In the end, Sentara decided to go with a vendor that had more of an integrator perspective, one that was regarded as an expert in the field of identity management, Initiate Systems.

Sentara chose Initiate Systems because identity management was their single focus and they had a need for the EMPI technology to work seamlessly in their complex, heterogeneous IT environment. Also, Sentara needed a fairly sophisticated and robust algorithm that could provide a higher level of matching and more consistency than they were getting from their existing system. They already had some basic programmatic matching logic incorporated, but believed once Initiate’s algorithm was implemented; it would give them a better product.

The first step of the implementation was to incorporate the Initiate software in a passive mode across six hospitals and their reference lab. The implementation began in passive mode so Sentara could begin to understand and address their duplication situation. The second step was for Initiate Systems to perform a data analysis on Sentara's hospital system. Not only would this analysis identify the number of duplicates, but it would give Initiate Systems the information they needed to help Sentara understand how to set thresholds within Initiate software, and going forward, how to manage their data in terms of duplicates. Once the analysis was complete, Sentara discovered they had a significant duplication rate, over 18%. They had attempted to address the duplication rate in the past through a remediation process, but due to either technology issues or because the cost of merging and cleaning up the duplicates across their many different systems was too high, they had not yet successfully reduced their duplication rate.

At this point, Sentara had too many systems connected that were using similar identifiers. The ideal situation would be for them to go in and clean up the duplications during the implementation. Unfortunately, they were unable to do that. So they asked Initiate Systems to help them take an unconventional approach to their duplication problem. Initiate Systems would implement the Initiate software and let the auto-linkage capabilities of the product begin to remove the duplicates within Sentara’s hospital system automatically.

Once the Initiate software was implemented, Sentara began to realize a significant amount of value by just having the product in place and running. Their duplication rate began to drop as they proceeded into the next phase, which was active integration.

The second phase of the project, which proved to be the most valuable, was the active integration with Sentara’s hospital-based registration system, McKesson HealthQuest. As Sentara began to communicate about the upcoming active integration to their 400+ registration staff, they noticed the registrars were starting to understand some of the errors that had been occurring in the past. The staff began to review their current processes, which enabled them to immediately identify training and process deficiencies. At that point, before the active integration began, Sentara’s duplication rate began to quickly drop, well below the 18% figure that was recorded earlier.

By the end of May 2004, active integration with the Initiate software was complete and Sentara had been successful. A total of six hospitals were now up and running, and their duplicate rate was reduced from 18% down to the 2% range.

“We relied quite heavily on Initiate Systems as it relates to some of the different needs we had around our duplicates,” said Sam Owens, Director of Systems Integration at Sentara Healthcare. “We implemented in a nonstandard way, so we really used Initiate Systems quite a bit in trying to understand how we could hook up APIs, integrate with all of our existing clinical and IT systems, and so forth. The entire implementation was quite successful, and all our hospitals are up and running.”

Today, Sentara is able to share information from their physician practice with the rest of the hospital. Physician satisfaction has significantly increased, and Sentara's duplication rate is much lower. In the past, they relied on human intervention to detect errors. Now, their EMPI automatically detects duplicates, which helps avoid patient safety issues from occurring.

With the implementation of Initiate software, it is also easier for the registrars to register patients. Registrars are required to enter more complete data, but it isn’t a wasted effort and work isn’t duplicated. Once the data is entered, it is kept throughout the registration process. Now when a registrar searches for a patient within their system, they get fewer and better results because of the efficiency of the searching and scoring algorithms. The most likely matches are presented first, making it easier for registrars to find the correct patient and less likely for them to make a mistake.

Initiate Systems helped Sentara drive value to their integrated healthcare network by:

• Improving accuracy of patient identities – The accuracy of patient identities has been significantly improved across the healthcare system due to the sophistication of the EMPI algorithm and core technology.
• Providing comprehensive applications – Initiate software is a fully dedicated application that is used to manage patient identity tasks as they arise.
• Enabling enterprise-wide access – Sentara’s EMPI system can be easily accessed from other applications within the healthcare system, enabling them to quickly verify the identities of their patients.

Sentara has a list of projects on their plate for the near future. Currently, the EMPI is running in their six hospitals. However, they plan on deploying active integration with the physician practice, reference lab, scheduling environment and the health plan. Some other areas that are on their list of projects include implementing an EMR across both their hospital environment and physician office environment, actively integrating their long-term care division into the EMPI and enabling consumers to access their integrated healthcare network via their portal technology.