It was four years ago when the Dallas-Fort Worth Hospital Council (DFWHC) Foundation discovered that up to 25 percent of readmitted patients were not returning to their original health system for care, making it difficult to accurately predict and track readmission rates. This realization reinforced DFWHC Foundation’s decision to develop a regional enterprise master patient index, an immense database that allows hospitals to track readmissions and other patient information across a diverse North Texas market.
Today, 80 hospitals—including multiple health systems and acute care hospitals, as well as rehabilitation and psychiatric hospitals—participate in the DFWHC Foundation’s regional enterprise master patient index. Used in conjunction with other business intelligence tools, the patient index reviews claims data from participating hospitals. Hospital members can access the tool with a simple click, pulling up dashboards and benchmark reports. The patient index tracks more than 100 quality indicators for members, including healthcare-acquired conditions, readmissions, and other metrics.
Hospitals have used the index, which is designed to match and manage 8.5 million patient records, to help reduce readmissions by 20 percent across member facilities. Hospitals are also using the benchmark information to help guide other improvement efforts.
For example, one DFWHC hospital reduced its all payer 30-day acute myocardial infarction readmission rate from 12 percent to 9 percent and its 30-day pneumonia readmission rate from 16 percent to 12 percent. The hospital achieved these results by providing aggressive, upfront case management to patients who seemed likely to be readmitted, based on their demographic and clinical similarity to patients who had been frequently readmitted in the past.
Most healthcare leaders are familiar with the master patient index tools embedded within their organizations’ patient registration and IT systems. These tools allow providers to accurately link electronic health data to the right patient. Going a step further, an enterprise master patient index has the ability to sit on top of many IT solutions to link data across an entire enterprise. The DFWHC Foundation has taken yet another step, allowing patients to be identified and tracked between hospitals and health systems.
The tool enables members to easily access standardized data to measure value and quality improvement. Because of the index’s inter-facility tracking capabilities, quality indicators can be monitored more accurately and addressed accordingly. As part of the DFWHC Foundation member agreements, data is productively shared between competitors to help identify and spread best practices for quality improvement.
DFWHC addressed patient privacy and security concerns outlined in the HIPAA and HITECH Act in three ways. First DFWHC shared its reporting elements and structure with legal counsel that specialized in healthcare privacy and security regulations. Second, university researchers and faculty periodically verify the low probability of prohibited patient re-identification using the index. Third, the organization has integrated security measures in place to protect patient information for all services.
The DFWHC Foundation staff is now working to expand the regional enterprise master patient index to include long-term care facilities so members can better track patients across the continuum. In addition, they are currently in the process of building a physicians’ claims warehouse.
In addition to quality improvement and readmissions initiatives, DFWHC Foundation hospital members are now using the regional enterprise master patient index for other projects that support community health, research, and workforce initiatives.
Studies and research. Emory University?a participating DFWHC Foundation organization?is using the patient index to study connections between ozone levels and emergency department (ED) admission rates among patients with asthma and heart conditions. Likewise, the University of Texas Southwestern Medical Center is using data from the patient index to study long-term heart disease and outcomes.
Population health management and assessment. DFWHC Foundation members are now using outpatient data across the region to identify disease states in patient populations. They can measure how often inpatients and outpatients interact with a health system. For instance, the regional enterprise master patient index monitors ED visits, particularly for patients with multiple and chronic conditions, allowing providers to intervene before patients reach emergency status. This data can then be trended to determine whether clinical programs are effective from a population health perspective.
Tracking and trending ED use. Because 25-30 percent of North Texas patients are uninsured, many use the ED—rather than a primary care provider—for non-emergent conditions. DFWHC Foundation members are identifying non-emergent conditions and tracking “frequent flyers” to reduce unnecessary ED visits.
Blending clinical and administrative data. Twenty-six North Texas organizations performing cardiovascular surgeries have used the patient index to match patients between a clinical registry and claims warehouse. This allows organizations to see not only patients’ clinical attributes, but their encounters before and after surgery to conduct effective population studies.
A regional enterprise master patient index is most helpful in large metropolitan areas, states with many health systems like California, or regions spanning multiple states on the East Coast. Providers considering participation in a regional enterprise master patient index may consider the following tips:
Make it a collaborative effort. Technology is only an enabler. Participants must be willing to work together and committed to the idea that collaboration offers great gains in patient care rather than lost resources.
Don’t attempt to create a regional enterprise master patient index with a newly formed network. The initiative requires sophisticated knowledge, healthy collaboration, and a willingness to share sensitive information. Instead, work with an existing network of organizations. For example, more than a decade before implementing its patient index, the DFWHC Foundation forged partnerships with member organizations to support other healthcare initiatives, including patient medication management programs.
Obtain support from leadership as well as the community. To fully optimize a regional enterprise master patient index, the leaders of hospitals and health systems, universities, and health-related businesses must understand its value and the potential for innovation. For example, the DFWHC Foundation includes provider leadership and community members on its board, which has helped accelerate the impact of the regional enterprise master patient index data across the region.
Engage state leaders. State organizations such as the Texas Healthcare Information Collaborative and the Texas Institute of Healthcare Quality and Efficiency have a strong interest in the regional enterprise master patient index and its ability to improve healthcare quality and efficiency. The patient index presents opportunities to match data across registries and Medicaid that can lead to cost reductions and quality improvements. For example, by identifying specific populations that require health interventions, state agencies and healthcare providers can partner to help patients receive appropriate care.
Dedicate financial resources. Developing a regional enterprise master patient index requires a financial investment. Therefore, organizations should identify what they want to achieve, and then determine if the ROI is worthwhile.
For example, to participate in the North Texas patient index, providers must be a paying member of the Dallas-Fort Worth Hospital Council Foundation’s Information and Quality Services Center. Many facilities evaluate their use of the index by measuring their potential Medicare patient/program losses over a 30-day period and then determining the value of avoiding and reducing penalties by being able to accurately measure their readmissions on a regional, inter-system basis through the patient index.
An accepted belief in health care is “that which is documented is improved.” By establishing an effective regional enterprise master patient index, hospitals can maximize clinical and financial data to enhance quality care for patients across an entire geographical region. Through collaboration and dedication, establishing a regional enterprise master patient index is one way to bolster patient care while ensuring long-term financial viability.
Kristin Jenkins, JD, FACHE, is president of the Dallas¬–Fort Worth Hospital Council Foundation, Irving, Texas.
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