In north Texas, more than 80 hospitals have put aside their competitive concerns to work together on a regional master patient index that is improving care throughout the region.
In the late 1990s, a committee of local hospital and health system leaders organized by the Dallas-Fort Worth Hospital Council Foundation came up with the idea for a regional database that would allow all the healthcare organizations in the hospital-crowded area to track patients' health encounters, even when those encounters happened at an outside health system.
"They foresaw a need for a regional master patient index to address population health needs and track readmissions," says Kristin Jenkins, JD, who has served as president of the DFWHC Foundation since 2008. "There had not been an initiative like this before, one that created a master patient index outside aligned corporate entities, but they anticipated a need for it."
at the time a suitable IT product for this endeavor wasn't yet on the market, so the committee partnered with an outside health IT company to work with the DFWHC Foundation to develop an index that could perform high levels of patient-matching on a regional basis. The following years were spent creating and optimizing an algorithm that was able to match information from disparate sources and link together multiple records for a single patient.
The DFWHC Foundation began implementing the system in 2009, and since then has collected and matched records for more than 8.5 million patients across 83 area hospitals. Patient matches are made with 99.7 percent accuracy, says Ms. Jenkins.
The initial focus of the patient index was better readmission tracking. Mindful of looming penalties, participating hospitals used the index to see which patients had been readmitted to a nearby but unaffiliated hospital. "They quickly learned about 20 percent of readmissions were happening outside the original health system," says Ms. Jenkins. "But because they had that information from the index, they were able to better analyze the characteristics that made people more likely to be readmitted and were able to focus on early interventions for that subgroup."
The index has also been used to identify patients who routinely use the emergency department for non-emergent care. Ms. Jenkins explains the Dallas-Fort Worth area's high rate of uninsured patients coupled with a physician shortage leads to significant overuse of hospitals' EDs. However, these patients often visit various hospital and health system's EDs, making it difficult for a single hospital to identify individual over-users. "But with the patient index, we are able to track how many times a patient visits any ED in the area," she says. Analysis of this data was also able to identify specific comorbidities, including diabetes and mental health disorders, which were associated with high use of emergency services.
This information, along with other insights from the patient index, is made accessible to participating hospitals through interactive dashboards. The population health information gleaned from the index has helped many participating nonprofit hospitals complete their required community needs assessments, says Ms. Jenkins. The DFWHC Foundation has also made the patient index available to the regional health information exchange, allowing for a smoother launch of the HIE with fewer patient duplications.
"Even though the original thought was to use this to track readmissions, there are so many uses for it," says Ms. Jenkins.
Ms. Jenkins believes the DFWHC Foundation patient index is the only one of its kind in the country, an idea that is supported by the numerous organizations from throughout the country that contact her to ask about the program and its successes. But what makes the patient index truly unique, she says, is the motivation behind its founding.
"The area's hospital leaders came up with an idea that was truly innovative in a community sense, agreeing to share information they were not required to share with one another to better analyze the bigger population health issues and improve things in the care model," says Ms. Jenkins. She cites Doug Hawthorne, CEO of Arlington-based Texas Health Resources, Joel Allison, CEO of Dallas-based Baylor Scott & White Health, and Ron Anderson, MD, former CEO of Parkland Memorial Hospital in Dallas, among others, as instrumental in making what she sees as a fundamentally selfless decision to improve care delivery throughout the region.
"The leaders of these systems were visionary, as well as brave to care more about the community than competition," she says. "I really admire their decision and I am thrilled to see the benefits it has afforded our entire community for more than a decade."
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