A Healthy Hub Works WondersA Healthy Hub Works Wonders

Customers have come to judge companies on how well integrated their touch points are. When different stores in a chain don't have access to the same customer data, the customer usually feels inconvenienced rather than protected from privacy invasions. The same judgments apply to healthcare companies. Patients can't always switch providers as nimbly as they can switch grocery stores, but by the same token they're unlikely to switch back to a provider they've left — especially in the near term.

The stakes are higher in healthcare than in retail for yet other reasons. Imagine having a patient who is away from home, alone and in great physical distress — yet you can't administer medication before consulting the data silo of the patient's home hospital or doctor. Sometimes this means waiting for an overnight courier to deliver a hard copy of a medical record. The life-or-death consequences and liability exposure of missing or incorrect data is a much more serious problem in the healthcare industry than in others. Even in less dire circumstances, duplicated efforts and medical tests, incorrect or missing data and inconsistent medical records translate into hefty costs, regulatory compliance problems and public relations headaches for healthcare companies.

In consideration of some of these risks and costs, Sutter Health decided in 2001 to integrate data across its heterogeneous systems. The not-for-profit organization includes 26 community hospitals plus physician organizations and facilities for long-term care, home health, hospice and occupational health throughout Northern California. Each location can have as many as a dozen systems — best of breed and legacy, on various platforms and from various vendors — for applications such as patient billing and accounting, registration, lab, radiology and pharmacy.

The healthcare industry generally approaches the problem of patient identity reconciliation through an "EMPI," or enterprise master person index. Sutter, which chose to use a customer data hub product for its EMPI, refers to it as enterprise master person identity: "identity" because "index" refers to a system that uses a consistent customer ID across all systems. The Initiate Identity Hub software from Initiate Systems that Sutter used to create its EMPI instead identifies individuals based on patient demographic data.

The EMPI keeps a master record of patient demographic information to prevent overlap (redundant, often inconsistent records), overlay (insertion of one patient's data into someone else's record) and duplication of data entry efforts.

Sutter took the first stage of the project live in November 2002, a year after signing the contract with Initiate Systems. This initial stage integrated three facilities on the Med Series4 registration system, the Emageon PACS radiology system and a Park City Solutions portal. Since then, Sutter has integrated its Apollo Medical Systems cardiology application, inpatient and outpatient electronic medical records systems and the Sutter Health Enterprise Warehouse.

The various applications interact with the EMPI in several ways. Many legacy applications connect to the hub through industry-standard HL7 messaging. Some are able to connect through Initiate's application programming interface (API), a method Sutter prefers. With both the HL7 and the API techniques, the integration-related changes in the legacy applications are unobtrusive to users who may have a years-long familiarity with these systems. The integration isn't just unobtrusive, it helps the user work faster and more accurately: Instead of asking a new patient for full demographic information at intake, for example, the user can search the hub (through the familiar application) to pull up the patient's data from a past encounter or visit.

Sutter also uses Initiate's data quality algorithm. It makes probabilistic matches, which are more accurate than rules-based or deterministic matches. It has been preventing many data quality problems at the point of entry. Furthermore, Sutter has been analyzing Initiate-derived data to identify users who habitually introduce data errors so that those people can be retrained. In medical records generally, one in 20 contains errors, so prevention and cleanup of bad data can contribute a sizable benefit to the enterprise and to the customer.

Plans are underway to create new applications within the next two years that further leverage the hub. One will be an expansion of the physician portal into an electronic health records system, which will give providers quick and accurate access to federated patient data. Sutter will also create a Web application so patients can securely renew prescriptions and get doctor approval through their Web browsers.