July 21, 2017
New Jersey will soon roll out a database designed to improve patient care, reduce medical errors, and ensure that healthcare records are accessible to providers across the state, regardless of where a person has sought treatment in the past.
The New Jersey Innovation Institute is creating the state's so-called Master Person Index in an effort to connect physicians, hospitals, pharmacists, and other healthcare providers so they have better access to patient data. The system, which will link to public health databases as well, will also help ensure that no two patients with the same name and identifying characteristics are confused by providers, a situation that could lead to misdiagnosis, mistreatment, and dangerous outcomes.
Pilot project ahead
The $3.72 million effort - funded with a combination of Medicaid dollars and money from the federal Office of the National Coordinator for Health Information Technology - will go online later this month as a pilot project connecting electronic health records from two major facilities in Newark, University Hospital and Newark Beth Israel Medical Center, according to NJII. In October, the MPI will be rolled out for use by participating providers statewide.
At first, the system will allow users to connect with patient data collected by a half-dozen regional entities that have coordinated millions of records for patients but aren't currently connected, NJII said. The team will then try to link to other physician groups, clinics, drug stores, and other entities that contribute to medical records in an effort to create a coordinated system throughout the Garden State.
"It will be an ongoing journey to make sure everybody is signed up and part of it," noted Jim Cavanagh, a healthcare consultant who once oversaw technology at St. Joseph's Healthcare System, in Paterson. "It's likely to be 80 percent (of providers) fairly soon," he said, but connecting to the remaining 20 percent may take time.
'Fundamental' and 'foundational'
"We see it as fundamental and kind of foundational to a lot of things we are working on right now," Cavanagh added, explaining that connecting to quality data is critical if providers are going to be effective in managing population health, reducing the impact of chronic conditions, and keeping people healthier.
Tomas Gregorio, the senior executive director for the healthcare innovation lab at NJII, said medical errors remain a major killer nationwide. "We believe that being able to identify a patient should be able to help with that," he said.
Cavanagh agreed. "The reality is, something like getting the right patient, you'd be surprised how much of a problem that is in healthcare."
Reimbursement and care
Patient data has become an essential part of the way healthcare is provided, measured, and paid for, with a growing focus on connecting physician reimbursement to quality care. As electronic health records have become the standard, experts are now looking at how to get the most out of the information collected and stored in these systems.
The Camden Coalition of Healthcare Providers was among the first groups nationwide to use regional hospital records to identify patients with significant medical needs - "frequent fliers" at the area's clinics and hospitals - and target them for specific care, a process that improved outcomes and reduced cost.
Data is also a critical part of the state's public health plan, Healthy New Jersey 2020, a blueprint to improve population health and reduce racial and other disparities that brought the state Department of Health national recognition for its public health work. And Gov. Chris Christie has expanded the reach of the state Prescription Monitoring Program to help prescribers and pharmacists to guard against doctor shopping by individuals seeking opiates for illicit use or sale.
Linking to public health databases
But there is not yet a system in New Jersey that connects providers with these existing public health databases, or allows them to access patient records maintained in other areas of the state. The six Health Information Organizations started in 2009 compile data from participating providers in their area; some HIOs consist of a handful of hospitals, while others coordinate electronic patient records from several dozen providers, Gregorio said. Only two of them use the same software to compile records, he added.
"This led to groups of disparate islands with no bridges between them," Gregorio explained. So the Department of Health contacted NJII, a corporation of the New Jersey Institute of Technology, asking them to find a way to pull the data together.
Cavanagh said many states have already created similar master healthcare indexes that give providers access to more patient data, but the systems are hard to get right. NJII is now working with a subcontractor to design a system that works best for the Garden State.
"The platform is only half the battle," he added. "You still have the issue of the quality of the data collected."
Since there is not a standard system for electronic health records, there is significant variety on how entries are to be made, Cavanagh explained. As a results, the NJII team has had to sift through a diverse set of files, seeking to confirm each patient's identity from a mix of demographic factors, health history, and more modern approaches, like cellphone use and even shopping preferences - techniques now used regularly by online retailers and tech companies.
"It's a combination of old and new" sources of data, he said, which will help them be sure they are not mixing up two patients with the same name. Security will be the responsibility of NJII, he said, and the group is now working out a legal framework that will govern who exactly will have access