determine if a patient has presented before, the organization lacks the advanced query, match and data stewardship features needed and, as a result, suff ers from the convenient creation of duplicate patient records and multiple patient identifi ers. Additionally, these embedded MPIs are inadequate to man-
age more complex situations, such as the addition of patient populations from an organizational merger, the intentional obfuscation of personal details by drug seekers, imposters seek- ing care under someone else’s credentials and the accidental hijacking of an existing patient record through a perfectly normal interaction. In the latter case, a staff member pulls up a record they be-
lieve is associated with the patient, but in actuality it is not, and makes a change to the record. For example, a patient named Eva Rodriguez calls her doctor’s offi ce to schedule an appointment. T e scheduler locates a record for an Ava Rodriguez, and verifi es her phone number and insurance. T e insurance happens to be the same, but Eva provides a new phone number, which is corrected on the patient record. When Eva arrives at the ap- pointment, the same record is retrieved, and more verifi cation questions are asked, resulting in a change to the address fi eld. When Eva meets with her physician, the physician asks detailed clinical questions based on the information in the record, and they both discover that the record is not Eva’s, but Ava’s. T e record has been “hijacked” and unintentionally changed
over time. Fortunately, the misidentifi cation was caught in time to avoid any adverse treatment, but there are still conse- quences: the patient-provider relationship was breached when Ava’s personal health information was discussed, the physician’s confi dence in the technology erodes, the health information management (HIM) staff spends hours returning the record to its original state and the patient questions the integrity of the organization, impacting customer satisfaction. In addition to the medical repercussions of failing to iden- tify patients accurately, there are other ramifi cations that carry signifi cant costs in time, resources and money. T e plague of duplicate patient records triggers repeat testing, redundant administrative activities, time wasted to investigate and resolve the records, inaccurate billing, malpractice settlements and public relations issues. My provider organizations have between 8 and 13 percent of their medical records duplicated – and sometimes as high as 22 percent. In multi-facility environments, where disparate application systems are integrated, the percentage of duplicates can surpass 30 percent. Fortunately, there is an approach that has proven success-
ful over the years to address the challenges in patient identity management and reduce the creation of duplicate records. A vendor-neutral enterprise master patient index (EMPI) is de- signed to compare patient records from disparate systems and indicate the probability that two records are duplicates, unique
or potentially duplicate. By using probabilistic matching al- gorithms that incorporate phonetic similarities, variances in typographical entries and dates, aliases and the relative “weight” of specifi c comparators, an EMPI signifi cantly improves the patient identity process. T e EMPI assigns a unique identifi er for the patient and maintains a list of all other identifi ers associated with that patient, such as multiple medical record numbers (MRNs), enabling a translation or a “map” from one identifi er to another. T is feature allows external systems to share information for the same patient, even though each system is only familiar with its “local” identifi er. Additionally, the EMPI can aggre- gate data from the patient’s diff erent records into a single best record, creating a source for consistent, reliable patient demo- graphic information for use across the enterprise. Organizations
derive maximum value from an EMPI when it is incorpo- rated into front-end processes, such as patient registration. Instead of searching only the local MPI for a patient record, a registrar can search the EMPI, taking advantage of its ad- vanced query capa- bilities and larger patient population, and determine if the patient has been seen at any facility previously. T e patient’s MRN is available, which eliminates the need to create a new one. As an added bonus, demographic information can be updated while the patient is present. Imprecise patient identity management leads to fragmented data, mismatched and corrupted patient records, and dimin- ished data integrity, all of which contribute to patient safety concerns. Without a sophisticated method to compare records from any system and provide a consistent and reliable source of patient information across the enterprise, the business and eff ectiveness of delivering quality healthcare is signifi cantly impacted. T e use of an EMPI, however, provides precise matching technology that identifi es a higher rate of potential duplicate records, enables a patient-centric view and reduces a major cause of unnecessary complications and poor quality of patient care.
organizations have between 8 and 13 percent of their medical records duplicated – and sometimes as high as 22 percent. In multi-facility environments, where disparate application systems are integrated, the percentage of duplicates can surpass 30 percent.
HMT HEALTH MANAGEMENT TECHNOLOGY March 2013 11