All In Webinars - All In: Data for Community Health · 9/6/2017 · sector data integration to...

Meeting Information

▪ Conference Line: 1-631-992-3221

▪ Access Code: 295-004-040 #

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▪ Technical difficulties? Email [email protected]

mailto:[email protected]

Master Person Indexes:

A Tool for Population Health

Management

September 6, 20171:00 p.m. – 2:00 p.m. ET

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All In: Data for Community Health

Data and

Information Sharing

Multi-sector

Partners

Collaborative Effort

Outcome:

Capacity Building to

Drive Community Health

Improvement

Support local initiatives that focus on:

Projects in All In, with more joining

5

All In: Mission and Goals

1. Support a movement acknowledging the social determinants of health

2. Build an evidence base for the field of multi-sector data integration to improve health

3. Utilize the power of peer learning and collaboration

▪ Trade association that represents California’s public health care system

▪Co-hosting this webinar with All In

▪Audience today includes:

▪ 21 county and University of California systems that form the core of the safety net in CA

▪ Other communities across the country that are members of or follow All In

Agenda▪ Introductions

▪ MPI Case Study #1: Stephen Singer, MCP, Senior Manager of Data

Analytics at Camden Coalition of Healthcare Providers

▪ Share how Camden Coalition uses and continues to evolve their person-level

matching using various methodologies in the research settings.

▪ MPI Case Study #2: Daniel Chavez, MBA, Executive Director at San

Diego Health Connect and a former CHP Subject Matter Expert

community

▪ Share how San Diego Health Connect is using an HIE and addressing

standards to improve automated patient matching capability.

▪ Facilitated Q&A / Discussion

▪ Get Involved with All In

Speakers

Stephen Singer, MCP

Senior Manager of Data Analytics,

Camden Coalition of Healthcare

Providers

Daniel Chavez, MBA

Executive Director,

San Diego Health Connect

Considerations& Questions

RecordLinkage

about

& MPI’s

Stephen Singer, Senior Manager, Information Architecture & Data Analytics

Education & Employment

Official ID & Vital Records

Food & Nutrition

Reproductive Health

MentalHealth

Medication & Medical Supplies

Provider Relationships

Health Maintenance

Substance Use Disorder

Other

Benefits & Entitlements

Shelter

Legal

Transport

Advocacy & Activism

Family, Personal & Peer Relationships

16 Domains of Care, only 4 or 5 are “medical”

Our HIE

contribute

read

/wri

te read

read

analysis in ,

, …

Internal performance & care tracking

HIE

real-time,vendor-managed

home-grownPostgreSQL database of integrated longitudinal administrative & outcomes data

research & quality improvement

user-customizable,vendor-hosted.

viz & interactive dashboards in, , , , …

processing & analysis in

CamdenARISE

The Camden Coalition Data Environment

Cross-sector Integrated Data “System”Existing Multi-Sector Data Sharing:1) All-payor hospital claims from 4 regional health systems

biannual (plus a 1 time extract from a 5th)

2) State Medicaid Claims monthly

3) Camden Police Department no fixed schedule

(arrest, call-for-service, & overdose)

3) Camden City School District moving to weekly

(enrollment, truancy, absenteeism, & suspension data)

4) Camden County Jail (booking & release) daily

5) NJ State Prison (booking & release) bi-monthly

6) property data (citywide vacancy survey) one time

In Discussion:1) Homelessness Management Information System

2) State Mortality Records

Integrated Identifiers Hospital Claims

State Medicaid

School District

Police Arrest

SatePrison

County Jail HMIS

Death Cert.

First Name

Middle Name

Last Name

Name Suffix

Alias

Date of Birth

Date of Birth Alias

Date of Death

Gender

Race and/or Ethnicity

Street Address

Zip Code

City

State

County

SSN

MRN

Federal Bureau of Prisons #

State Bureau of ID #

State/Local Bureau of Criminal ID #

Inmate ID

Family ID

Family Members

To resolve existing data dis-integration (linkage)& prevent future data dis-integration (data management) So that we can correctly identify & characterize patients for appropriate & coordinated care, accurate quality metrics, and research.

Why

MPI?an

So that the infrastructure of the system of care mirrors and supports the kind of care you want to deliver, rather than fighting against it.

or...

But

!

• Some data are undecidably ambiguous-- there is simply not enough information to disambiguate.

• Most linkage studies claim accuracy rates in the 95% range even though the gold standard is by nature unknown.

• The biggest gains in link quality are generally gained in 2 places: • data cleaning (and • the method of comparing values (“fuzziness”) not in

reference data or link algorithm tweaks.• Data entry is only partially controllable.• Data entry isn’t the only source of error.

Hospital 1Database

Hosptal 2Database

Merged Data

processing

Business Rules

Record Linkage

Vendor Database

clerical errornoiseobfuscation

this whole process somewhere else

omission

contamination

Manual Entry

Record Import

Medical Device

documentation error

unimplemented feature

extract error analysis files

linkage error

technical glitch

design constraints

data structure mismatch

Data Manipulation

clerical errornoise,

& obfuscation

this whole process somewhere else

omission

contamination

documentation error

unimplemented feature

extract error

linkage error

technical glitch

design constraints

data structure mismatch

Errors, errors,everywhere!

hospital mrn dob last first mid ssn

W 1 06/03/1965 SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965 HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1 0

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5

16 RUIZ-SMITH LARRY N 296 1 4 6 4 1 1

SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

mrn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

06/20/1965 RUIZ BEN

foneticfirstlastd.o.b.


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


296 1 1 6 5 1 1

06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

296 1 3 6 8 4 4

296 1 4 6 5 1 0

06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

06/20/1965 RUIZ SYMON L 296 1 7 5 5 6 1

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

296 1 4 5 5 6 0

296 1 7 6 4 1 1

296 1 7 6 5 1 1

06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1



W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

06/20/1965 RUIZ BEN

06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1



W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

296 1 4 6 5 1 0

06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

06/20/1965 RUIZ BEN

06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

06/20/1965 RUIZ BEN

06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1

hospital mrn dob last first mid ssn296 1 4 6 4 1 1

06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

296 1 4 6 4 1 1

06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

06/20/1965 RUIZ BEN

06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

296 1 4 6 4 1 1

296 1 4 6 4 1 1

296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1

hospital mrn dob last first mid ssn1 06/03/1965 SMITH SIMON 296 1 4 6 4 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5

16 06/20/1965 RUIZ-SMITH LARRY N 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

mrn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

06/20/1965 SMITH LARRY

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

06/20/1965 SMITH LARRY

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1



W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON 296 1 4 6 5 1 0

6 06/20/1965 SMITH LARRY 296 1 3 6 5 5 5

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY 296 1 4 6 5 1 0

296 1 3 6 5 5 5

296 1 3 6 5 5 5

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY 296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1



W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

6 06/20/1965 SMITH LARRY 296 1 3 6 5 5 5

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

10 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

11 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

10 06/20/1966 SMITH LARRY N 296 1 4 5 8 8 8

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY 296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

mrn&ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

6 06/20/1965 SMITH LARRY 296 1 3 6 5 5 5

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

10 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

10 06/20/1966 SMITH LARRY N 296 1 4 5 8 8 8

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY 296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

mrn&ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

6 06/20/1965 SMITH LARRY 296 1 3 6 5 5 5

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

10 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

11 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

10 06/20/1966 SMITH LARRY N 296 1 4 5 8 8 8

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY 296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

mrn&ssn


W 1 06/03/1965SMITH SIMON 296 1 4 6 4 1 1

2 06/20/1965HIGHSMITH 296 1 4 6 5 1 1

3 RUIZ BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X 5 BENN N 296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y 7 RUIZ BEN L 296 1 3 6 8 4 4

296 1 4 6 5 1 0

8 SYMON 296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N 296 1 7 5 5 6 1

10 SMITH LARRY 296 1 4 6 5 1 0

06/20/1966 296 1 3 6 5 5 5

11 296 1 3 6 5 5 5

10 296 1 4 5 8 8 8

12 06/30/1966RUIZ JAMES 296 1 4 6 4 1 1

Z 13 06/20/1965 BEN 296 1 4 5 5 6 0

14 296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15 SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5


SMITH

296 1 4 6 4 1 1

296 9 8 6 8 4 3

15 06/30/1965RUIZ SIMON 296 1 4 6 4 1 1


2 06/20/1965 HIGHSMITH SIMON 296 1 4 6 5 1 1

3 06/20/1965 RUIZ BEN 296 1 1 6 5 1 1

4 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 1

X 5 06/20/1965 RUIZ BENN N 296 1 4 6 5 1 0

5 06/20/1965 RUIZ SYMON N 296 1 4 6 5 1 0

6 06/20/1965 SMITH LARRY 296 1 3 6 5 5 5

7 06/20/1965 RUIZ BEN L 296 1 3 6 8 4 4

7 06/20/1965 RUIZ BEN L 296 1 4 6 5 1 0

8 06/20/1965 RUIZ SYMON L 296 1 4 5 6 1 0

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

9 06/20/1965 RUIZ SYMON N 296 1 7 5 5 6 1

10 06/20/1965 SMITH LARRY N 296 1 4 6 5 1 0

10 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

11 06/20/1966 SMITH LARRY N 296 1 3 6 5 5 5

10 06/20/1966 SMITH LARRY N 296 1 4 5 8 8 8

12 06/30/1966 RUIZ JAMES 296 1 4 6 4 1 1

13 06/20/1965 RUIZ BEN 296 1 4 5 5 6 0

14 06/20/1965 RUIZ BEN 296 1 7 6 4 1 1

14 06/20/1965 RUIZ BEN 296 1 7 6 5 1 1

13 06/20/1965 RUIZ BEN

14 06/20/1965 RUIZ LARRY J 296 1 4 6 5 1 1

15 06/20/1965 RUIZ SYMON 296 1 4 6 4 1 1

15 06/20/1965 RUIZ SIMON 296 1 4 6 4 1 5


16 06/20/1965 SMITH LARRY N 296 1 4 6 4 1 1

16 06/20/1965 SMITH LARRY 296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

mrn&foneticfirstlastd.o.b.


W

1 06/03/1965 SMITHSIMON

296 1 4 6 4 1 1

2

06/20/1965

HIGHSMITH 296 1 4 6 5 1 1

3

RUIZ

BEN 296 1 1 6 5 1 1

4 SIMON 296 1 4 6 4 1 1

X5

BENNN

296 1 4 6 5 1 0

SYMON 296 1 4 6 5 1

6 SMITH LARRY 296 1 3 6 5 5 5

Y

7

RUIZ

BEN

L

296 1 3 6 8 4 4

296 1 4 6 5 1 0

8

SYMON

296 1 4 5 6 1 0

9 296 1 7 5 5 6 1

N10

SMITH

LARRY

296 1 4 6 5 1 0

06/20/1966296 1 3 6 5 5 5

11

10 296 1 4 5 8 8 8

12 06/30/1966

RUIZ

JAMES 296 1 4 6 4 1 1

Z

13

06/20/1965

BEN

296 1 4 5 5 6 0

14296 1 7 6 4 1 1

296 1 7 6 5 1 1

13

14 LARRY J 296 1 4 6 5 1 1

15SIMON 296 1 4 6 4 1 1

296 1 4 6 4 1 5

16

RUIZ-SMITH

LARRYN 296 1 4 6 4 1 1

SMITH296 9 8 6 8 4 3

15 06/30/1965 RUIZ SIMON 296 1 4 6 4 1 1

2 296146511 WILLIAM HIGHSMITH 6/20/1965

14 296146511 LARRY RUIZ 6/20/1965

14 296176411 JOHN RUIZ 6/20/1965

14 296176411 JOHN RUIZ 6/20/1965

5 296146510 JON RUIZ 6/20/1965

5 296146510 WILYAM RUIZ 6/20/1965

16 296986843 LARRY SMITH 6/20/1965

16 296146411 LARRY RUIZ-SMITH 6/20/1965

16 296146411 LARRY SMITH 6/20/1965

12 296146411 JAMES RUIZ 6/20/1966

15 296146411 WILLIAM RUIZ 6/30/1965

15 296146411 WILLIAM RUIZ 6/20/1965

15 296146415 WILLIAM RUIZ 6/20/1965

Deterministic linkage groups together records that are equal, or approximately so, on subsets of identifier fields.

MRN SSN First name Last name Date of birth

Probabilistic linkage calculates a total score for two records to determine how likely it is that both refer to the same individual. The total score is the sum of scores generated by the comparison of individually weighted fields.

non-match match

reviewregion

sum of field scores for a given record pair

number of record pairs

at each cumulative

score

false negative false positive

But…bursting theLinkage Bubble

• Probabilistic is better when assumptions hold• high linkage rates• consistent rates of error across the dataset• independent variability of identifier values

• Linkage success depends on geography, ethnicity, poverty, and other health-correlated variables. So the narrower and more vulnerable the population segment, the worse the data are. e.g. Hispanic compound names, Vietnamese

transliteration

Still… when it works there is this:

TrackVia

jail

HIEclaims

Still… when it works there is this: …and this:

1. How soon? How fast?2. How expensive?

($ + training + staff-hours)3. How flexible & stable?4. How interoperable?5. How accountable & transparent?

Buy

Build?vs

1. Can I get ALL of my data back?2. How do you do it, really?3. Who can I talk to…

outside of sales and marketing?4. How responsive is tech support?5. Can you flag records by linkage quality?

questions

vendor:for any 5

So:Know the data.Know the sub-population.Choose the appropriate method,

not the “best” method.

Relationships come before data.Integrated data is not the goal,

integrated care is. Integrated care is built on relationships.Relationships can be built on data.

Patient Records MatchingOvercoming the largest obstacle to health

information exchange: One HIE’s story

Daniel Chavez, Executive Director

San Diego Health Connect

March 3, 2016

Addressing health-related social needs will likely require an ecosystem approach, with hospitals and health systems working with health plans, federal, state, and local governments, community organizations and local businesses, employers, and families, to implement initiatives that impact health and quality of life…

51

Healthcare’s Ultimate Goal Is To Improve Outcomes

CLAIMS

Diagnoses

Prescriptions

Care Events

CLINICAL

Lab Results

Radiology

SOCIAL

Family

Location

Employment

OTHERNon-Medical

Events

Connected Medical Devices

Foundational To This Goal Is The Ability To Develop Complete, Secure, Comprehensive, And Longitudinal Records For Every Patient

Better Outcomes

The SDHC Mission

Our MissionTo connect healthcare stakeholders to deliver quality, comprehensive information for better care.

When every individual’s health information is securely available to their doctors when and where they need it:

• Doctors can provide better, more informed care.• Duplication of tests and procedure decreases.• Costs go down.

Participating organizations

Health and Human Services

Trusted health information exchange…

HL7

FHIR

ISO

Is built on

technical

interoperability

CCR

SNOMED

DICOM

LOINC

NCPDP

RxNorm

CPT

ICD-9/10

Uses document

standards to

achieve functional

interoperability

Patient Matching:

No false positives

Minimal false negatives

Is enabled by

semantic

interoperability

It Is Extremely Difficult To Match The Same Patient’s Records Within An

Organization

Claim

Claim

Lab

Claim Lab

It Is Exponentially More Difficult To Match The Same Patient’s Records Across

OrganizationsClaim

Claim

Lab

Claim

Lab

LabDevice

Job

ClaimClaim

Rad.

Claim

Demographic Data Is The Key To Linking Patient Information

NameAddressDate of BirthGender

CLAIMS

Diagnoses

Prescriptions

Care Events

CLINICAL

Lab Results

Radiology

SOCIAL

Family

Location

Employment

OTHER

Non-Medical Events

Connected Medical Devices

SSNMRNInsurance IDEmailPhone

Almost Always Present Sometimes Present

There Is A Better Way

Reg. EMR

Labs Rev

1st generation 2nd generation 3rd generation

MPI Enterprise MPI Universal MPI

The Healthcare Industry’s Patient Matching Challenges Can Be Solved By A Nationwide “Universal” Master Patient Index (MPI)

Identity Consolidation

Reg.

LabsEMR

Rev EMR

eMPI

Identity Integration Identity Interoperability

uMPI

Rev LabsEMR Reg. EMR

MPI

What Does A Universal MPI Look Like?

Pre-Populated Reference Database

1

Nationwide Reference Demographics From Non-

medical Sources.

New “Referential Matching” Architecture

2

More Accurate.No Tuning.

Cloud-Based3

Just Plug In.

The Foundation Of A Universal MPI Is A Large Reference Database Of Identities Spanning The Entire US

Reference Database

Data Sources

Billions of Records

CREDIT

TELCO

GOV’T /LEGAL

Intuition-Based

Algorithms

Data Science

Over 350MIdentities

30 Years Of Historical Data

Millions Of Updates Per Month

An “Answer Key” For Demographic Data

Referential Matching vs. Probabilistic Matching

A

✓Match

A B

X No Match

B

Universal MPI Acts As An “Answer Key” For All Matching Questions

Referential MatchingProbabilistic Matching

MPI

How Would It Work?

Lab EHR Rx

VirtualPrivate MPI

Millions Of Updates Per

Month

Universal MPI

1. Use APIs To Match Patients To Their Universal Identities

2. The Universal Identities Organize And Link Your Patients

3. Periodic Updates Flow To You, Helping Manage Your Linkages

Coordinated Cross Sector Care

64

Connecting All for

Better Health & WellnessCOMMUNITY INFORMATION

EXCHANGE

@

The Care Management Challenge

• Lack of knowledge and consensus

• Absence of standards or tools

• Best practice still evolving

• Healthcare = social services

• Lack of multi-sector coordination – Who does what? Who is in charge?

• Rigid and various technology systems

• PHI versus PII

• Sharing data across sectors is a major challenge

65

Relevant Segments in Common

• EMS

• Homeless

• Serious Mental Illness

• Veterans

• City of San Diego

• Elder population

66

Fully Integrated Information Exchange

67

Social Behavioral Medical

Comprehensive Longitudinal Health Record

C

O

O

R

D

I

N

A

T

I

O

NLongitudinalCommunity Record

LongitudinalMedical Record

Connect/Communicate/Referrals

Person ID System

Legal/Consent

Summary• Must be persistent in collaboration

• Reduce redundancy• Patient identities and records matching – PHI v. PII

• Solve shared care management

• Clinical to community linkages• Closed loop referral handoff

• Continue sharing lessons learned

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Learn More

▪ CHP Learning Guide: The Story of San Diego’s Community Health Information Exchange: Data Sharing, Care Coordination, and Population Health http://www.academyhealth.org/publications/2017-06/data-sharing-care-coordination-and-population-health-learning-guide

▪ Meet staff from the Camden Coalition and National Center for Complex Health and Social Needs at the National Conference

Putting Care at the Center 2017

November 15 – 17, 2017, Los Angeles, CA

https://www.centering.care/

Early bird $595 (ends October 2) / General Admission $725

http://www.academyhealth.org/publications/2017-06/data-sharing-care-coordination-and-population-health-learning-guide

https://www.centering.care/

Get Involved with All In

▪ Visit our website: allindata.org

▪ Join the online community: allin.healthdoers.org

▪ Follow #AllInData4Health on Twitter

▪ Sign up for a monthly newsletter from All In

▪ Speakers Contact Info

▪ Stephen Singer: [email protected]

▪ Dan Chavez: [email protected]

http://www.allindata.org/

http://www.allin.healthdoers.org/

https://twitter.com/search?q=#AllInData4Health&src=tyah

https://visitor.r20.constantcontact.com/manage/optin?v=0010YFcABXlzqUB3Nt1U4lBbSg4bnWwIdKl4FcM3xEsIyYBno54W_TRK65Es3dqXebANoyoiz1fndzHeWzagPXsEj0TTxb1zdzaFk6Pi3BTxkyv4VVNjf3jkT594ZRYGs93JyIfmfmRCE4WZD0TdgdkYh8ejbpdrHQFzaitYf7RqYxcvkKGbpSbrA%3D%3D



Next Steps

▪ Share your feedback

Please complete the evaluation survey following the webinar

▪ Resource list, slides, and recording will be posted

Available online at allindata.org/resources

Thank you for joining us today!

http://www.allindata.org/resources/

All In Webinars - All In: Data for Community Health · 9/6/2017 · sector data integration to...

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