Patient matching: Sequoia Project, BCBSA case study shows 99.5% accuracy

The Sequoia Project and the Blue Cross Blue Shield Association say new research shows promise for expanding an existing person matching framework to payers – boosting the prospects for more seamless interoperability as patient identification efforts gain steam in policy circles and at provider organizations.

The new study, Person Matching for Greater Interoperability: A Case Study for Payers, shows extremely high matching accuracy rates, the groups say, and offers perspectives that can help boost patient identification efforts across the health plans – a must-have for more expansive health information exchange and interoperability.

The Sequoia Project worked with BCBSA to apply its Framework for Cross-Organizational Patient Identity Management – first developed with Intermountain Healthcare, back in 2016 – to the payer community, expanding opportunities for more accurate person matching.

The cross-organizational framework’s first iteration detailed how provider-to-provider matching and exchange could be optimized, describing best practices and offering a maturity model to point the way toward more widespread improvements in nationwide patient matching.

Since its publication, a Patient Identity Framework Work Group was convened, and the stakeholder feedback led to a revised version two years ago that has since served as a guide for many providers and HIEs nationwide.

The new case study, meant as a supplement to that, homes in on payers, and the case study it offers – an algorithm enabling a 99.5% matching accuracy rate across 36 different organizations – suggests big potential for other healthcare stakeholders going forward.

“Since our provider-focused framework was published in 2016 and revised in 2018, we’ve seen tremendous interest in how we apply those principles to raise the floor for interoperability,” said Sequoia Project CEO Mariann Yeager in a statement.

“When the Blue Cross Blue Shield Association agreed to collaborate on the application of these principles to the unique needs of the payer community, we were thrilled for the opportunity to work together to expand our thinking from ‘patient matching among providers’ to ‘person matching in other settings.'”

Patient matching and identification efforts have gained some momentum in recent months, after being a major hindrance to interoperability for years.

In July, the U.S. House of Representatives voted to overturn a longstanding hurdle to developing a unique patient identifier – approving the Foster-Kelly Amendment, which removes language that prohibits federal funding for research into a unique patient ID.

And so groups such as the Patient ID Now coalition are lobbying policymakers in Washington to push for a national strategy to address patient identification.

When it comes to interoperability, “there are just too many fundamental gaps,” said Hal Wolf, CEO of HIMSS, a member of Patient ID Now. “We’ve done a great job, the United States, of developing components of HIE. But there’s an underlying dependency that we’re missing, you know, and that’s the individual patient identifier.”

The COVID-19 pandemic has put a harsh spotlight on the need for better patient matching, as Congressional leaders were reminded this spring by the Pew Charitable Trusts.

“Congress should work with federal agencies – such as the Office of the National Coordinator for Health Information Technology and the U.S. Postal Service – to ensure that they are using all the available tools they have so that public health entities can effectively trace contacts and track immunizations,” said Ben Moscovitch, Pew’s project director for health information technology.

He pointed to the fact that phone numbers aren’t often exchanged between labs and public health authorities who could do contact tracing. In many cases, even if they are, the numbers are for ordering physicians, not patients.

“As a result, contact tracers spend indispensable time searching for a phone number or email address to contact an individual,” he said, “all while the virus may be spreading by unknowingly infected individuals that have not been reached via contact tracing mechanisms.”

“The ability to match someone with their health data – regardless if they’ve changed insurers – is critical to ensuring people receive the care they need and deserve,” said Rich Cullen, vice president at BCBSA in a statement.

“To address this health industry need, we developed a way to safely and securely match a person’s health data from one Blue Cross and Blue Shield company to another. We believe this will lay the foundation for larger health data-sharing efforts within the broader health care system. We thank The Sequoia Project for their expertise and collaborative leadership, which is critical now as we continue to advance industry standards to make meaningful health information easily accessible.”

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a HIMSS publication.

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