Simple Workflow Changes Enable Effective Patient Identity Matching in Poison Control

Cummins, Mollie; Ranade-Kharkar, Pallavi; Johansen, Cody; Bennett, Heather; Gabriel, Shelley; Crouch, Barbara Insley; Fiol, Guilherme Del; Hoffman, Matt

doi:10.1055/s-0038-1667000

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…Analogous efforts to improve HIE between U.S. poison control centers and EDs have successfully used user-centered design and changes in staff documentation practices to improve system usability and increase the accuracy of patient match algorithms, respectively. 23,24 These strategies should also be considered to overcome the challenges associated with prehospital information exchange. The continued development of FirstNet-a high-speed, national broadband network to be exclusively utilized by first responders 25 -may also offer increasing opportunities to advance communication at the EMS-ED interface and further integrate EMS providers within the larger emergency care networks in which they operate.…”

Section: Discussionmentioning

confidence: 99%

Health Information Exchange in Emergency Medical Services

et al. 2018

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Background The Office of the National Coordinator for Health Information Technology has outlined the benefits of health information exchange in emergency medical services (EMSs) according to the SAFR model—search, alert, file, and reconcile—developed in collaboration with the California Emergency Medical Services Authority. Objective This scoping review aims to identify and characterize progress toward the adoption of prehospital health information exchange, as reported in the peer-reviewed literature. Methods A structured review of literature in MEDLINE-indexed journals was conducted using the “Electronic Health Records” topic-specific query, the “Emergency Medical Services” Medical Subject Headings descriptor, and a prehospital identifier. Results Our initial search yielded 368 nonduplicative, English-language articles; 131 articles underwent full-text review and 11 were selected for analysis according to pre-established inclusion criteria. Original research was thematically grouped according to the SAFR model. Conclusion Within isolated systems, there has been limited progress toward the adoption of prehospital health information exchange. Interoperability, accurate match algorithms, security, and wireless connectivity have been identified as potential barriers to adoption. Additional research is required to evaluate the role of health information exchange within EMSs.

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Section: Discussionmentioning

confidence: 99%

Health Information Exchange in Emergency Medical Services

et al. 2018

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“…In particular, PCCs pose a logical but especially challenging use case for HIE because they typically do not collect a robust set of patient identifiers. 16 , 17 For example, UHIN has the capability to push HL7 C-CDAs forward to the Utah PCC for all state-wide ED patient encounters that match to PCC consultation notes. We worked together to develop this process, but it has not been implemented because it is dependent upon definitive patient identity matching.…”

Section: Discussionmentioning

confidence: 99%

Enabling health information exchange at a US Poison Control Center

Cummins

Fiol

Crouch

et al. 2020

Journal of the American Medical Informatics Association

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Objective The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. Materials and Methods We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. Results We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. Discussion With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. Conclusion As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.

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“…For instance, the Newborn Screening dataset, characterized by numerous incomplete records and poor field quality, was the only dataset that exhibited worse performance in the original analysis compared to the sensitivity analyses (Table 4). Depending on the dataset type and record quality, the framework and subsequent reviewer training could be refined in the future 34 . Second, many studies have deemed manual review too expensive for research and care delivery applications, as it demands substantial personnel and technical resources 22 35 .…”

Section: Limitationsmentioning

confidence: 99%

“…Depending on the dataset type and record quality, the framework and subsequent reviewer training could be refined in the future. 34 Second, many studies have deemed manual review too expensive for research and care delivery applications, as it demands substantial personnel and technical resources. 22 35 Nevertheless, due to increased federal funding and the high costs associated with erroneous record matching, some institutions have recently prioritized manual review.…”

Section: Limitationsmentioning

confidence: 99%

Manual Evaluation of Record Linkage Algorithm Performance in Four Real-World Datasets

Gupta,

Xu,

et al. 2024

Appl Clin Inform

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Background: Patient data is fragmented across multiple repositories, yielding suboptimal and costly care. Record linkage algorithms are widely accepted solutions for improving completeness of patient records. However, studies often fail to fully describe their linkage techniques. Further, while many frameworks evaluate record linkage methods, few focus on producing gold standard datasets. This highlights a need to assess these frameworks and their real-world performance. Objective: We use real-world datasets and expand upon previous frameworks to evaluate a consistent approach to the manual review of gold standard datasets and measure its impact on algorithm performance. Methods: We applied the framework, which includes elements for data description, reviewer training and adjudication, and software and reviewer descriptions, to four datasets. Record-pairs were formed and 15,000 records were randomly sampled from these pairs. After training, two reviewers determined match status for each record-pair. If reviewers disagreed, a third reviewer was used for final adjudication. Results: Between the four datasets, the percent discordant rate ranged from 1.8-13.6%. While reviewers’ discordance rate typically ranged between 1% and 5%, one exhibited a 59% discordance rate, showing the importance of the third reviewer. The original analysis was compared to three sensitivity analyses. The original analysis most often exhibited the highest predictive values compared to the sensitivity analyses. Conclusion: Reviewers vary in their assessment of a gold standard, which can lead to variances in estimates for matching performance. Our analysis demonstrates how a multi-reviewer process can be applied to create gold standards, identify reviewer discrepancies, and evaluate algorithm performance.

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Simple Workflow Changes Enable Effective Patient Identity Matching in Poison Control

Abstract: Historical processes and procedures for matching patient identities require adaptation or added functionality to adequately support the PCC use case.

Cited by 4 publications

References 7 publications

Health Information Exchange in Emergency Medical Services

Health Information Exchange in Emergency Medical Services

Enabling health information exchange at a US Poison Control Center

Manual Evaluation of Record Linkage Algorithm Performance in Four Real-World Datasets

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