In the case of St. Joseph Health (SJH), based in Orange
County, CA, they tested the use of neural network technol-
ogy to resolve high volumes of ambiguous linkages or tasks.
The data in these ambiguous linkages, which heretofore rep-
resented fragmented records, is critical to serving the needs
of population health, consumer engagement, and numerous
types of analytics. “Our data-driven initiative that began in
2012 prioritizes freeing data, sharing data, and using data
to meet health systems’ strategic initiatives,” says Theo Sia-
gian, director of HIE and interoperability at SJH. “Having a
significant volume of ambiguous linkages impeded meeting
these priorities. In a proof of concept project, the supervised-
learning technology (neural network) is constantly improved
by mimicking the behaviors of our best data stewards, and
freeing these individuals to address the more complex am-
Further, Kathy Fitzgerald, RHIA, director of HIM and pri-
vacy officer at SJH, stated that “resolving ambiguous data sets
must be timely, as delays impact data use.”
“Applying machine learning through neural networks ‘train-
ing’ helps us meet our goals in this era of cost containment and
data analytics,” Fitzgerald says. “We can resolve in a few weeks
what would have previously taken a team of people months or
years, and save an estimated 80 percent of the expense.”
SJH engaged a multi-stakeholder group of business and
technology professionals to evaluate technologies, consider
governance implications, and quantify benefits (see the side-
bar on page 29), as well as consider issues such as privacy and
security. Daily and monthly dashboards and statistics are
used to guide SJH patient identity governance activities, and
integrate these foundational activities with the enterprise
Innovating with a Proprietary, Unique Patient Identifier
Provider organizations and payers are continuing to innovate in
unique patient identifications. This may take the form of real-time or batch queries for a unique identifier that is held by a
third party, frequently a healthcare business unit of a credit bureau. These unique identifiers are not universal, but rather proprietary to the vendor and their customers.
Michael Skvarenina, CIO at Holy Name Medical Center
in New Jersey, says that provider organizations already do
considerable business with credit bureaus for eligibility
and credit inquiries, so extending that business model for
patient identification is logical. “And, these organizations
have already addressed with the credit bureau the common
concerns of privacy, security, and trust,” Skvarenina says.
“A unique identifier created and maintained by a credit bu-
reau can yield tremendous benefit particularly since their
data is constantly updated, thus providing most current de-
mographics for population health and prevention services,
as well as data warehouses.”
Innovation and Governance: A Natural Partnership
Innovation in patient identity should go hand in hand with existing or new data governance activities.
Innovation in patient identity should also naturally involve
multi-stakeholder data governance councils or workgroups who
may first consider a variety of strategic information governance
perspectives, as sampled below, in addition to how innovation
will be applied. This group should ask:
Who owns the responsibility for the integrity of each identifier, particularly if a new identifier is created?
If existing data is augmented with new external data, how is the
new data integrated, and lifecycle of the new data managed?
What are the acceptable uses for the identifiers in consideration of HIPAA personally identifiable information (PII),
HIPAA privacy, and HIPAA compliance?
How can/should an organization incorporate the patient
identity technology with the long-standing human data
steward work to ensure an enterprise compliance and governance perspective?
As organizations evaluate innovation for patient identity, it’s
important to elevate the discussion to a data or information governance realm.
Organization and healthcare professionals are understandably cautious in applying innovation to this long-standing
problem, as the consequences of mismatching records can
be profound. But this caution is not a reason to do nothing
and wait for a silver bullet that some believe will come with
a national healthcare identifier. Rather, when considering innovation, be prudent in assessing the potential risk, impact,
and benefits. Consider a few basic steps when exploring the
application of innovation:
Innovation discussions should not only be a technology
discussion, they should involve people, process, and technology and support data governance.
Get business people involved if they aren’t already. The
multi-stakeholder group must include patient access/regis-tration, health information management, and the technology team, and could include data users such as care coor-
Applying Innovation to the
Patient ID Challenge
Many organizations have hundreds of thousands—or even
millions—of electronic records that can’t be used in transformational
activities because they can’t automatically be matched/linked
to other records.