Abstract
Background Patients often seek medical treatment among different health care organizations,
which can lead to redundant tests and treatments. One electronic health record (EHR)
platform, Epic Systems, uses a patient linkage tool called Care Everywhere (CE), to
match patients across institutions. To the extent that such linkages accurately identify
shared patients across organizations, they would hold potential for improving care.
Objective This study aimed to understand how accurate the CE tool with default settings is
to identify identical patients between two neighboring academic health care systems
in Southern California, The University of California Los Angeles (UCLA) and Cedars-Sinai
Medical Center.
Methods We studied CE patient linkage queries received at UCLA from Cedars-Sinai between
November 1, 2016, and April 30, 2017. We constructed datasets comprised of linkages
(“successful” queries), as well as nonlinkages (“unsuccessful” queries) during this
time period. To identify false positive linkages, we screened the “successful” linkages
for potential errors and then manually reviewed all that screened positive. To identify
false-negative linkages, we applied our own patient matching algorithm to the “unsuccessful”
queries and then manually reviewed a sample to identify missed patient linkages.
Results During the 6-month study period, Cedars-Sinai attempted to link 181,567 unique patient
identities to records at UCLA. CE made 22,923 “successful” linkages and returned 158,644
“unsuccessful” queries among these patients. Manual review of the screened “successful”
linkages between the two institutions determined there were no false positives. Manual
review of a sample of the “unsuccessful” queries (n = 623), demonstrated an extrapolated false-negative rate of 2.97% (95% confidence
interval [CI]: 1.6–4.4%).
Conclusion We found that CE provided very reliable patient matching across institutions. The
system missed a few linkages, but the false-negative rate was low and there were no
false-positive matches over 6 months of use between two nearby institutions.
Keywords
electronic health records/standards - health information exchange/standards - medical
record linkage/methods
