This paper considers the situation in Europe – that is, broadly, the European Economic Area (EEA) and Central and Eastern Europe – and shows how sophisticated data matching and record linking techniques, such as an enterprise master person index (EMPI), support rapid, accurate patient identification which is essential to enabling effective health information sharing to deliver better healthcare at lower cost.

1. IBM Software Group, Information Management Healthcare
White Paper
Unified View of Patient Data
enables Better Healthcare
at a lower cost

2. 2 Unified View of Patient Data enables Better Healthcare at a Lower Cost
Executive Summary
Unified View of Patient Data enables Better Healthcare at a Lower Cost
The European Union, Central Europe and countries around the globe have recognised the value of care coordination and
are building or updating their eHealth infrastructure to connect and share information. Accurately identifying and matching
patient records across systems to create a unified view for eHealth applications is a must. However, it is not an easy challenge
to solve.
• National identifier systems which are capable of validating insurance coverage or administering payments are not typically
built to support the level of accuracy and complex, real-time information sharing required to enable coordinated care across a
broad and distributed set of healthcare providers.
• Legacy systems have a lot of rich historical data that is important to include in a person’s medical record. These same systems
bring special difficulties to many organisations that can make it difficult, even impossible, to add a universal health identifier
(UHI) as an attribute.
• Protecting patient privacy is a significant concern due to the sensitivity of health information. Most if not all countries have
regulations limiting the use and distribution of a patient’s health information.
• Government authorities and healthcare providers alike are challenged with providing cross-border healthcare to an even
wider range of citizens of very different cultural and linguistic backgrounds. And semantics and culture vary widely across the
continent.
Rapid, accurate patient identification, coupled with a unified view of the patient’s medical history at the point of care
irrespective of where the data is held, is vital to meeting the EU’s goal of providing better healthcare at lower cost.
This paper considers the situation in Europe – that is, broadly, the European Economic Area (EEA) and Central and Eastern
Europe – and shows how sophisticated data matching and record linking techniques, such as an enterprise master person
index (EMPI), support rapid, accurate patient identification which is essential to enabling effective health information
sharing to deliver better healthcare at lower cost.

3. Healthcare 3
Unified View of Patient Data
enables Better Healthcare
at a Lower Cost
Contents Accurately linking patient records across disparate
3 Introduction and Overview systems to enable secure information sharing is
4 European challenges in linking information critical to the success of any eHealth initiative.
5 Building and maintaining a high Healthcare leaders around the world recognise the need to leverage
quality data foundation information and communication technology (ICT) to improve
6 The power of the enterprise master person efficiencies, enable coordinated care delivery and control costs. A
index (EMPI) significant challenge, however, is harnessing and managing information
about a patient when it is distributed across providers in individual system
6 The importance of speed, flexibility and scalability silos that aren’t built to interoperate or share information.
of the EMPI
6 Following standards and protecting privacy Aggregated information obtained from procedures, hospital stays or
with the EMPI outpatient visits, as well the effects of attendant social care or responses
to medication, is valuable for coordinated care. When anonymised, it
7 Conclusion
can also be used in research and analysis for future planning and
delivery of healthcare services.
The European Union, Central Europe and countries around the globe
have all recognised the value of care coordination and are building or
updating their eHealth infrastructure to connect and share information.
Accurately identifying and matching patient records across systems to
create a unified view for eHealth applications is a must. However, it is
not an easy challenge to solve.
The European Parliament particularly notes, in its reports and
discussions on cross-border healthcare, the need to improve electronic
systems for patient identification. The EU’s eHealth Action Plan writes
of ‘the need to identify a person unambiguously’ as being ‘an important
component’ of any national or regional eHealth infrastructure.
Canada Health Infoway, Singapore, Australia and many U.S.A. health
information exchanges call for patient and provider registries as part of
their electronic patient record (EPR) infrastructure to ensure accurate
and secure patient identification and health information sharing.

4. 4 Unified View of Patient Data enables Better Healthcare at a Lower Cost
In response to the realisation that patient identification is Irrespective of the initiative or the eHealth approach, the
paramount for eHealth, some governments have issued health common element is the patient. It is important to have robust,
ID cards or extended the use of a national identifier (beyond a powerful and flexible systems capable of interoperating in a
benefits and payment system) as a means to identify patients. standardised way to identify patients rapidly and accurately,
Developing or extending the use of a health identifier is link the right records to the right patients and securely provide
something which appears straightforward, but it’s harder than a full view of their medical history to authorised providers,
it looks. In fact, it can be difficult at best, and many times something which a good enterprise master person index
impossible, to add a health identifier to a legacy system to (EMPI) is proven to help deliver.
enable accurate identification and information sharing with
other systems.
National identifier systems which are capable of validating
insurance coverage or administering payments are not typically
Sorting out the Jones’s records
Wales is a country of three million people bordering the
built to support the level of accuracy and complex, real-time
west of England and washed by the Bristol Channel and
information sharing required to enable coordinated care across
a broad and distributed set of healthcare providers. Nor are the Irish Sea. People variously speak English or Welsh or
they built to support privacy requirements that many regions both. It’s part of the UK but has many powers devolved
to the Welsh Assembly, health included. In 2003, the
or countries are adopting.
Assembly established the Informing Wales Health Care
Programme (IWHCP) to improve Welsh healthcare,
European challenges in accurately
something now developing well.
identifying and linking patient health
information Information was fractured and scattered not only through
There are special challenges to European healthcare. the seven health boards but also among both hospitals
Semantics and culture vary widely across the continent. and individual departments. Patients had a multiplicity of
Certain languages dominate but there are perhaps forty in identifiers and there were numerous duplicate patient
reasonably common use in various countries and regions. records. Further, some Welsh names are widespread and
the likes of Margaret Jones or Thomas Davies were at
The patient’s language and that of whoever enters data into the high risk of having their records confused with those of
system may vary and mistakes will inevitably occur. In addition, others.
government authorities and healthcare providers alike are
challenged with providing cross-border healthcare to an even IWHCP identified correct patient identification as a key
wider range of citizens of very different cultural and linguistic need and contracted with IBM to deploy the IBM Initiate
backgrounds. Patient EMPI as part of the eHealth architecture. This
brought additional benefits to the NHS Trusts merger
For example, the project Smart Open Services for European programme and helped the development of the Welsh
Patients (epSOS) exists to develop and evaluate a service Clinical Portal.
infrastructure demonstrating cross-border interoperability
between electronic health record systems in Europe. Also, the Earlier, it was difficult and time consuming to search
Single Market provisions generally allow any EEA national to several administrative systems to track down patient
live and work in any part of the community or EEA area, information. With the IBM Initiate Patient EMPI at the
showing their entitlement typically through possession of the foundation of the eHealth architecture in Wales, clinical
now mandatory European Health Insurance Card (EHIC). staff now see unified patient views, learn instantly where
These broad-based initiatives, coupled with the local supporting records are held and can order tests online.
challenges of providing care for a culturally diverse population, “Much quicker,” enthused one doctor. “It’s just like
bring some complex issues when it comes to interconnecting internet shopping!”
systems and securely and accurately sharing information.

5. Healthcare 5
Building and Maintaining a High Quality
An IBM study of one nation’s highly controlled universal
Data Foundation
identifier found some surprising figures that indicated
Life events such as moving house or work, changing names,
data quality issues and missed opportunities for linking
divorce or marriage, or even death, are consequent to data
patient records together for the EPR. The study showed:
degradation within a system and also impact the ability to
match and share health records. This is a serious but not
• 4%–5% of the records in the system were duplicates.
uncommon problem. Many estimates indicate data inaccuracies
• Of the 13 million records spread across 12 different
that exceed 8% of a client file. In a million record database,
systems, only 5.1 million were unique. This indicates a
that would be 80,000 inaccurate records.
high degree of overlap across organisations, which
means that patients have records in more than one
Cleaning data is expensive and time consuming. In business,
system that are not being linked together.
poor data quality or inability to identify relationships across
• Nearly 800,000 (6%) of the records had missing or
systems means poor customer service and decreased profits; in
inaccurate dates of birth.
healthcare, it means poor service delivery, increased costs and,
• Nearly half (45%) of the phone numbers held were
at worst, compromised patient care and malpractice suits.
wrong, including 28% of the home phone numbers.
Consider the time and cost involved for patients who have to
This impacts a physician’s ability to contact and follow
undergo duplicate testing or who encounter adverse drug
up with patients.
interactions because records are not properly linked across
systems to create the single Electronic Patient Record.
Computer systems are very good at finding records that give The table below illustrates data from a country that has a
an exact match. If a patient is allocated a unique identifier, with national identifier. The health ministers and health IT
all the relevant records linked to that, and if the identifier is managers believed a national identifier would suffice for
entered correctly, then that person’s relevant records will be eHealth Initiatives. An attribute validity study was conducted
found. This is the argument for numbering passports and to determine quality checks on the capture rates. The data in
driving licences on a national scale. The logic flaw is not to do the table shows less-than-adequate capture rates on the health
with how computers work but in understanding how society identifier, phone and forename (middle), which degrades the
and human beings behave in real life. ability to accurately identify the patient and create a unified
view for health information sharing and coordinated care.
In healthcare, different clinical departments and services often
These low capture rates on key identifying attributes
use their own identifiers. Many do not use the national
compromise the eHealth initiatives.
identifier as the primary means of identification, or at all, due
to privacy concerns, system functionality limitations or simply Attribute Validity
because the systems are older than the number itself. Patient
Administration Accident and
Semantic and cultural differences can lead to difficulties in System (PAS) Emergency (A&E)
Source System ( 1,118,057 records) (208,000 records)
finding records. If a record is not found, then typically a new
Surname 100% 100%
patient ID will be created which may or may not include the
Forename (First) 100% 100%
person’s nationally assigned number.
Forename (Middle) 29% 24%
Gender 98.8% 100%
Although countries have national or health identifiers, that
does not mean that everyone “always” has one or that it is Birth Date 90.6% 99.2%
captured “100% of the time”. Reliance on any one data point is Health Identifier 41.9% 10.7%
risky. Using an array of data points is necessary to achieve the Phone 35.8% 90.9%
highest percentages of accuracy when linking records together. Address 99.5% 99.2%

6. 6 Unified View of Patient Data enables Better Healthcare at a Lower Cost
The power of the enterprise master • IBM Initiate Patient EMPI works in real time with sub-
person index (EMPI) second response capabilities to enable core healthcare
Healthcare is complex, with multiple disparate systems that applications to accurately identify the right patient and create
each ascribe to different data management techniques. While the unified view of health history, lab results and
the universal health identifier (UHI) can be very useful in pharmaceuticals for authorised healthcare providers.
managing identification, it really is merely one attribute among
many that should be used to identify a patient and effectively It’s important that systems on which care delivery organisations
share information across providers for coordinated healthcare rely should be both scalable and able to interface with legacy
delivery. systems. One of the worst experiences organisations have is to
find they’ve outgrown the computer applications on which
An EMPI, especially one that employs probabilistic matching, they rely and to have to face the disruption of taking a major
achieves highly reliable matching and linking of results to step to something new.
create a unified view of a patient for the healthcare system.
• IBM Initiate Patient EMPI is designed from the start to scale
For example, the probabilistic matching in IBM Initiate – if more capacity is needed due to expanding the number of
Patient, an EMPI, is proven to be invaluable for overcoming systems, records or patients, then simply expanding the
the semantic and cultural differences that exist in Europe. capacity of the solution is all that is required.
• Legacy systems have a lot of rich historical data that is
• It compares a number of attributes such as name and important to include in a person’s medical record. These same
demographic data such as date of birth, gender, phone and systems bring special difficulties to many organisations. For
address, along with the health identifier, to identify the best example, it may be impossible to add a UHI as an attribute.
possible match. • In contrast, the IBM Initiate Patient EMPI does not solely
• It accounts for common data matching challenges such as rely on the UHI for patient identification. It captures patient
nicknames, contractions, name transpositions and phonetics records using a multitude of identifying attributes along with
and homophones, such as Tom, Thom and Thomas, as well as the UHI and links to other systems to enable a single, unified
Gerald and Jerold. view of the patient – a much cleaner, faster and more efficient
approach.
The probabilistic matching of IBM Initiate Patient EMPI
provides a way of rapidly identifying the commonality across a Following standards and protecting
range of records despite their variation, so that authorised privacy with the EMPI
clinicians checking their patient’s record in the EPR or other Implementing information systems that are standards-based is
connected system can be confident that the view is both important to ensure long-term viability and interoperability.
accurate and complete. This complete view saves time and IBM has consistently been a leader in standards development
money, and improves the overall experience and safety for the and compliance.
patient.
• IBM is one of the early members of the Continua Health
The importance of speed, flexibility and Alliance, a non-profit open industry organisation of healthcare
scalability of the EMPI and technology companies who collaborate to promote
Healthcare is increasingly fast moving. Knowing immediately interoperability according to standards-based approaches in
whether a person in the Accident and Emergency unit is order to improve the quality of healthcare delivery.
diabetic or intolerant of certain medications or has a cardiac • IBM is also a long-standing member and active participant
abnormality may be critical in deciding how to act safely. For with IHE (Integrating the Healthcare Enterprise), an
general practitioners, it may be important to know whether a organisation which promotes standards-based health
patient is continuing with prescribed drugs – in this case, information sharing through real-world use cases.
seeing immediately on a patient’s unified record that a regular • IBM Initiate Patient has been consistently compliant with
weekly prescription has not been collected could be important HL7 requirements and offers an open platform which allows
evidence. for application development.

7. Healthcare 7
existing system environment to provide quick time to value
Health information sharing across a and ongoing returns on investment as your business needs
hospital network evolve.
Belgium is a federal state of eleven million people where
three different native languages are spoken: Dutch, Protecting patient privacy is a significant concern due to the
French and German. This adds considerable complexity sensitivity of health information. Most if not all countries have
to health information systems. regulations limiting the use and distribution of a patient’s
health information. In order for providers and patients to
A large public hospital network wanted a means of embrace the benefits of health information sharing, they must
accurately identifying and matching patient records be confident that the data is protected and only shared with
across its five hospital sources to facilitate the sharing of authorised individuals.
data for registration purposes and the clinical portal.
• IBM Initiate Patient EMPI does not require data to be moved
Data quality and inability to share information across to a central location. Instead, it creates a virtual index which
facilities was an issue prior to implementing IBM Initiate points to where the patient information resides.
Patient EMPI. Some 40% of patients are treated in more
than one hospital; because each hospital has a distinct When the downstream applications call upon the index for
database and its own system of codes, it was impossible to patient identification, a virtual composite view of the patient is
get unified views of patient histories. The existing systems returned linking all records for the patient together. The view
were using exact matching techniques for searching; can be comprehensive or limited in order to support local
because this made it difficult to find records, this resulted privacy requirements, the unique needs of each patient
in the creation of many duplicate records. In addition, administration or clinical system, and organisational
more than 20% of patients didn’t have a health identifier preferences.
on file, so using the Belgian health identifier was not a
reliable option for matching and linking records for Conclusion
health information sharing. An EMPI enables secure and accurate health information
sharing across disparate healthcare providers by matching and
IBM Initiate Patient EMPI is helping greatly. Records are
linking the right records to the right patient. This is something
matched and linked across systems to create a single view
which is difficult to achieve with the use of a UHI on its own.
even when data is incomplete. This has facilitated use of
the new clinical portal, where authorised physicians With the EMPI at the foundation of the eHealth
access a consolidated view of a patient’s records regardless infrastructure, healthcare organisations can deliver more
of which facility they visited. comprehensive and accurate information to applications like
patient administration systems, electronic patient records,
clinical portals and more, without solely relying on the UHI.
In today’s volatile economic climate, it is critical to maximise
the value of existing resources as well as invest in solutions that
Rapid, accurate patient identification, coupled with a unified
will result in quick return on investment.
view of the patient’s medical history at the point of care
irrespective of where the data is held, is vital to meeting the
An EMPI is a technology that can be implemented alongside
EU’s goal of providing better healthcare at lower cost. This is
existing systems to make an immediate impact on productivity
what the sophisticated technology of the IBM Initiate Patient
and have a long-term impact on the health information sharing
EMPI helps deliver in conjunction with the UHI and as part of
required to enable coordinated care.
the broader eHealth infrastructure.
• IBM Initiate Patient EMPI is highly configurable and
adaptable. It can be implemented in a few months into your

8. 8 Unified View of Patient Data enables Better Healthcare at a Lower Cost
About IBM Information Management
solutions for healthcare
The journey to sustainable healthcare systems starts with a
smarter approach to information sharing. IBM Information
Management solutions for healthcare deliver master data
© Copyright IBM Corporation 2011
management (MDM) capabilities that help stakeholders to
connect and share clinical information accurately, securely and IBM Global Services
Route 100
cost effectively. IBM Initiate Patient and IBM Initiate Provider
Somers, NY 10589
are a trusted foundation for information sharing around the U.S.A.
globe; they help healthcare organisations improve
Produced in the United States of America
collaboration to increase quality of care, streamline compliance November 2011
and increase patient and provider satisfaction. All Rights Reserved
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