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One Patient, One Number

Let’s say you see an internist at Bayview who refers you to a specialist at Hopkins Hospital. A few weeks later, for unrelated reasons, you spend time in the emergency room at Howard County General Hospital.

Now you’ve not only visited Johns Hopkins’ three hospitals, but you also have three separate medical record numbers. And if, say, you should require the services of Johns Hopkins Home Care Group, you could add as many as four more, giving you a total of seven medical record numbers, when all your care was provided by just one organization—the Johns Hopkins Health System.

The Health System receives between 3 million and 4 million outpatient visits a year, and yet its various entities share no common way to uniquely identify a patient. Thus, there is no easy way to bring together clinical documentation into one medical record.

Now, a comprehensive plan, developed last fall by a group of representatives from each of the entities, promises to build a model of integrated ambulatory care. The first step? A single patient identifier.

Today, each inpatient and outpatient gets a unique medical record number. Under the proposed plan, that medical record number would be used each time the patient visits any Health System entity, be it an acute-care hospital, a big ambulatory care center like Green Spring Station, or a Community Physicians clinic anywhere in Maryland. One patient, one number, no matter where that patient is seen.

“With that unique identifier,” explains Mark Bittle, the administrator of ambulatory operations, who is leading the initiative, “we will all know the patient by the same number. We can then draw together all the pieces of the patient’s various encounters into a single, enterprise-wide medical record.”

The single patient identifier is the first of several patient management initiatives that will take place over the next three to five years. These include simplifying scheduling and registration, linking and sharing clinical documentation throughout the Health System, and giving patients and providers a portal through which they can access information.

To deliver cohesive ambulatory services, business processes will have to be made uniform; core technologies, identified and deployed. Before a single patient identifier can be issued, for example, common data standards will have to be established. Only with a common language can documentation be shared and patients scheduled and registered across the enterprise. 

The single patient identifier probably won’t be issued until mid-2008, Bittle says. “But it will be a fundamental change, a concrete example of how we’re integrating our clinical practice across the Health System.”

Anne Bennett Swingle



Johns Hopkins Medicine

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