1. Patient Matching in the Indiana Network for Patient Care Shaun Grannis, M.D. M.S. The Regenstrief Institute and Indiana University School of Medicine

2. Regenstrief Beginnings  Endowed by Sam Regenstrief - inventor of the low cost dishwasher  Obsessed with process improvement  Supported the creation of the Institute in 1972 to apply process improvement to medicine

3. Regenstrief Institute  Regenstrief tasked in 1972 to “stitch” silos of medical information together -> the Regenstrief Medical Record System (RMRS/Wishard Memorial Hospital)  In 1994, began stitching together information across institutions (INPC/Indianapolis)  In 2003, working towards stitching the state together (INPC/Indiana)

4. A “Big” Repository by US Standards  In the system: -1.3 million patients, 5 million registration entities -24 million orders -660 million coded results -12 million dictated reports -8.8 million radiology reports -25 million prescriptions -480,000 EKG tracings -45 million radiology images  Added Per Year: -600,000 ambulatory encounters -50,000 inpatient encounters

5. Consolidating the Silos Immunization Registry Electronic Medical Record System Patient ID: 123LMNOP Name: Jane Doe DOB: 01/01/04 SSN: N/A Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Patient ID: 6789XYZ Name: Jane Ellen Doe DOB: 01/01/04 SSN:123-45-6789 Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Global Patient Index Concept Dictionary Global ID:45678 Name: Jane Ellen Doe Demographics.. MRF1 ID: OU81247 MRF2 ID: 4564356 PH MRF ID: 123LMNOP MRF3 ID:6789XYZ

6. Consolidating the Silos Immunization Registry Electronic Medical Record System Global Patient Index Concept Dictionary St. Vincent MRF Clarian MRF Wishard MRF Community MRF Public Health MRF Global Patient Index IUMG MRF Concept Dictionary The Indiana Network for Patient Care

7. Record Linkage  Deterministic -“All-or-None” -Rules based on exact agreement or disagreement  Probabilistic -Each identifier (Name, DOB, etc.) is associated with customized weights based on identifier agreement rates  Fuzzy Matching -Middle ground -Increases flexibility -Pragmatic approach

8. Global Patient Registry Linkage Algorithm Features  One record per assigned patient number per institution  Create logical links between each of these records  Match using social security number, patient name, birth date and gender  Use string comparator algorithm and phonetic transformations for near name matches  Implements the concept of a “patient group”

9. Global Patient Registry Assigning Authority Global #Local Pat #Patient NameBirth dateSex Hospital A99-1231456Sinkwell, Ralph J12-2-59M Hospital B123-0A47239Sinkwell, RJ2-12-59M Hospital A99-11032115Sinkweil, Ralph12-2-59 Hospital C101-0A3276Fredrick, Alice4-14-78F Hospital A101-02314590Fredrick, Alyce4-14-78F Global ID is for internal indexing only – not publicly exposed – not publicly exposed

10. Results Retrieval: Patient Selection Dialog

13. Results Retrieval: Global Patient Group Display

14. Results Retrieval Interface

15. Thank You! Shaun Grannis, M.D. M.S. The Regenstrief Institute sgrannis@regenstrief.org