The Building Blocks of Inter-operability

We identify and describe nine key, short-term, challenges to help healthcare organizations, health information technology developers, researchers, policymakers, and funders focus their efforts on health information technology–related patient safety. Categorized according to the stage of the health information technology lifecycle where they appear, these challenges relate to (1) developing models, methods, and tools to enable risk assessment; (2) developing standard user interface design features and functions; (3) ensuring the safety of software in an interfaced, network-enabled clinical environment; (4) implementing a method for unambiguous patient identification (1–4 Design and Development stage); (5) developing and implementing decision support which improves safety; (6) identifying practices to safely manage information technology system transitions (5 and 6 Implementation and Use stage); (7) developing real-time methods to enable automated surveillance and monitoring of system performance and safety; (8) establishing the cultural and legal framework/safe harbor to allow sharing information about hazards and adverse events; and (9) developing models and methods for consumers/patients to improve health information technology safety (7–9 Monitoring, Evaluation, and Optimization stage). These challenges represent key “to-do’s” that must be completed before we can expect to have safe, reliable, and efficient health information technology–based systems required to care for patients.

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“…last name, first name, date of birth, gender/sex, postal code, and full street address). 34…”

Section: Introductionmentioning

confidence: 99%

Current challenges in health information technology–related patient safety

Sittig

Wright

Coiera³

et al. 2018

Health Informatics J

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“…Override: The patient receives the medication subsequent to internal pharmacy review within 14 days of the serious drug-drug interaction alert. 2. Replacement: The patient receives another medication treating the same condition within 14 days.…”

Section: Methodsmentioning

confidence: 99%

“…Interoperability is a key factor in the quality of health care [1][2][3]. Many anecdotes describe information failing to reach a provider, or providers overlooking records belonging to the same patient, hindering clinical decision making [4,5].…”

Section: Patient Identification In the United Statesmentioning

confidence: 99%

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Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study

Sragow¹,

Bidell²,

Mager³

et al. 2020

JMIR Med Inform

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Background The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. Objective We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. Methods We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert’s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. Results Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. Conclusions Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.

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“…Upon a benefit change (employment change, Medicare eligibility, work injury, discount card usage, etc), if the new payor uses a different pharmacy benefit manager, that new pharmacy benefit manager typically does not obtain the patient's prescription history from the prior pharmacy benefit manager. (2) The payor chooses a new pharmacy benefit manager. When payors select a different pharmacy benefit manager, prescription histories are not always forwarded to the new pharmacy benefit manager.…”

Section: Patient Identification and Interoperability In Pharmacy Benefit Managersmentioning

confidence: 99%

Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study (Preprint)

Sragow¹,

Bidell²,

Mager³

et al. 2020

Preprint

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BACKGROUND The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. OBJECTIVE We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. METHODS We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert’s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. RESULTS Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. CONCLUSIONS Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.

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The Building Blocks of Inter-operability

Cited by 16 publications

References 10 publications

Current challenges in health information technology–related patient safety

Current challenges in health information technology–related patient safety

Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study

Universal Patient Identifier and Interoperability for Detection of Serious Drug Interactions: Retrospective Study (Preprint)

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