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says Carey, who also serves as president of
the Kentucky Health Information Management Association (KHIMA).
Although the KHIE currently operates
using an opt-in model only, it is
considering a no-consent model in the
future as it continues to add participants
and data, says Carey, who is helping to
research the model. Carey says HIM
professionals should definitely have input
into choosing the consent model as well
as answering more complex questions,
such as how to restrict data upon patient
request, how to operationalize changes that
patients make to their consent, and how to
address consent across state lines.
Engage in Patient Identity
Discussions
Data integrity is an essential element of
HIE and one in which HIM professionals
should be involved, says Caryl Greaves,
RHIA, MPA, CPC, senior HIM director
at Montefiore Medical Center in New York
City. Montefiore Medical Center is one of
25 participating facilities and providers in
the Bronx RHIO.
The Bronx RHIO is somewhat unique
in that an HIM committee made up
of HIM representatives from each
major participating facility focuses on
issues related to the integrity of patient
identity and ensuring an accurate master
patient index (MPI). Greaves, who is the
chairperson for the committee, says it’s
crucial for HIM professionals to lead the
discussions about patient identity.
“HIM individuals are the most qualified
individuals to handle this. If HIM is not
involved in HIE, I think it will be a failure,”
Greaves says. “There will be too many
instances where people should be matched
and aren’t or too many situations in which
people are matched who shouldn’t be
matched, and that’s dangerous.”
The HIM committee’s goal is to prevent
improper linking as well as minimize
the number of false negatives, meaning
patients who should have been linked
but who weren’t, Greaves explains. The
committee meets regularly to establish
rules around what can be automatically
matched versus what requires a manual
review. For example, some hospitals in the
RHIO may use Bronx, the abbreviation
BX, or some other variation (including
a misspelling) when recording patient
addresses. In these instances, the
committee decided that automatic links
can be made. On the other hand, if two
digits of a patient’s Social Security Number
are transposed—and all other data
remains the same—this would require a
manual review.
“It is a huge issue to match in your own
institution. It is exponentially much more
difficult across different enterprises,”
says Greaves.
HIE matching software is not as
sophisticated as many in the industry
hope it would be; however, improvements
will likely occur over time, says Nance
Shatzkin, principal at Shatzkin Systems,
Inc. in Croton-on-Hudson, NY, who also
provides IT consulting for the Bronx
RHIO. In the meantime, HIM’s role is—
and will continue to be—crucial. “I think
the committee has been instrumental
in exposing issues of potential risk,
developing approaches to help minimize
that risk, and in establishing policies
for the RHIO as the RHIO takes on a
stewardship role over the data,” she says.
Future Challenges
A lack of standards related to HIE
exchange (including interstate HIE) and
the reporting of meaningful use criteria
related to HIE also continue to challenge
the industry, says Shatzkin. “One of
the challenges quite honestly is that the
technology is changing. The iceberg is
moving while we’re standing on it. That
makes it harder for people to understand
what the options are,” she adds.
