The Pew/RAND white paper: New approaches to patient matching

August was certainly anything but a quiet news month despite peak summer holidays. The  forest fires in the West (where I live) and the heat in Europe (where I spent almost three weeks on holiday) proved to be major news, but there were plenty of healthcare topics getting attention, too — particularly the new RAND white paper, “Defining and Evaluating Patient-Empowered Approaches to Improving Record Matching.”

I was particularly intrigued by the patient-empowered focus of this study funded by the Pew Foundation Charitable Trust.   While Pew has funded other patient matching studies, this angle is unique. There’s a lot of work to be done, but RAND and Pew are posing serious, thoughtful questions and recommendations that warrant detailed multi-stakeholder review and action. In the past decade, so many changes have improved consumer experience in everyday life — imagine the possibilities if we can successfully apply those learnings to healthcare.

The paper proposes an incremental three stage approach that begins by using a mobile device to validate demographic data and engage consumers. The accuracy of the given cell phone number impacts the subsequent steps which expand consumer and provider engagement and special app development. Using cellphone in matching is not new but using a validated number would be.

I recall a presentation Dr. Scott Schumacher (IBM’s Chief Scientist for MDM) and I did over a decade ago to NCVHS where Scott demonstrated the increasing value of phone number in matching. In the decade since, this type of matching has become even more common in many industries and business practices. I think I’m illustrative of the technology-engaged consumer who is accustomed to this procedure for banking, credit cards, social media accounts, and many others uses. I suspect I have to validate my data and enter secure codes for new devices or applications at least twice a month. Even so, the study discusses a high rate of cell phone use that would seem to support this approach, but I don’t believe this truly corresponds to similar rate of consumers actually using (and comfortable with) these validation processes. RAND readily acknowledges the need to explore this in more depth.

The paper evaluates the 10 proposed solutions that were explored by the RAND researchers, the technical expert panel, and the subject matter experts. These solutions were evaluated against 11 criteria, but I would propose adding two additional criteria: simplicity and trust building. While these may be implied by the existing 11 criteria, simplicity should aid in quicker adoption and progress against the long-standing patient matching challenge. Trust is essential to engaging consumers and providers. Many commercial entities have introduced their SMS validation programs as a way to build trust, using terms like “trusted user” and “trusted device.” Healthcare should follow this lead.

RAND and Pew discuss the need for better data quality (hence step 1, validating cell phone numbers) to aid in patient matching, especially to improve matching across organizations like HIEs. I’m particularly glad they acknowledged that there is no silver bullet to the long-standing patient matching challenge — rather, a solution will take critical thinking and a willingness to explore new options, like the patient empowerment angle.  The abandoning of the CHIME Challenge last year illustrated that technology alone will not solve the longstanding challenge.

The need for strong data quality, data governance, and a multi-stakeholder approach rang true throughout the paper and recommendations, with recommendations are more quickly actionable than others. Recommendation 5 (covering the research impact of record matching errors and publicly reported matching rates) could be launched quickly by re-publishing and launching  the patient matching error rates in the ONC Interoperability Roadmap. Other recommendations may take longer, but they’re worth the effort.

I hope Pew can marshal the resources and engage industry groups to accelerate the pace by discussing — and piloting — unique ideas that apply lessons learned from other sectors. The white paper is a dense read, but it’s worth the time. In coming months, I hope we can discuss pilot projects underway and learn from their successes and challenges.