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Identity Crisis

December 31, 2009
by Kate Huvane Gamble
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The push to share data electronically - both inside and outside of the hospital walls - is forcing patient identification to the forefront

Mary Anne Leach

Mary Anne Leach

As healthcare organizations move further into an electronic environment, the need for an accurate system of patient identification is becoming increasingly evident. Errors resulting from duplicate patient records or incomplete information can incur significant costs, burden the administrative staff, and most importantly, compromise patient safety.

Smart CIOs are avoiding - or at least minimizing - these issues by establishing an enterprise master patient index (EMPI), a central repository of information that contains a unique identifier for every patient. And they are finding that having a clean patient index can play a key role in the success of data sharing initiatives. Not having one, on the other hand, can leave an organization out in the cold.

“The MPI and the EMPI function are absolutely critical to record integrity.”

Kerry Kerlin

Kerry Kerlin

“The MPI and the EMPI function are absolutely critical to record integrity,” says Mary Anne Leach, CIO at The Children's Hospital in Aurora, Colo. “All of the sophisticated tools on the planet aren't going to fix anything if the patient presents with different data.”

Cynthia Hyde

Cynthia Hyde

According to Kerry Kerlin, executive vice president at Stoltenberg Consulting (Bethel Park, Pa.), the market for patient authentication solutions is growing rapidly, with many CIOs turning to EMPI as either a stand-alone product or as part of an EMR suite. With all identification systems, he says, the goals are the same. First, data fields should be uniform, and the information should be accessible from any location within the hospital. “The second thing is to have enough detailed information associated with the patient - including address, social security number and birth date - that you can differentiate between similar records and verify a patient's identity,” he says. “You want the ability to do a quick search on your database to try to prevent mistakes.”

One of the most common mistakes, Kerlin says, is having multiple records for a single patient. Providence Hospital, a Mobile, Ala.-based facility that is part of Ascension Health (St. Louis), was seeing duplication rates as high as 14 percent before implementing Reston, Va.-based QuadraMed's Smart Identity Management solutions. Providence's IT team worked with the vendor to clean up the existing database and install a system that could be more easily managed, says Cynthia Hyde, CIO and assistant vice president of information services. “We needed to do something on the back-end, because we were spending so much in the way of resources managing the duplicates, and we knew that our EMPI was getting less data integrity day by day.”

So Providence implemented QuadraMed's tool that tracks activity by registrar and department to help determine where errors are occurring. Since going live with the software in 2008, Hyde says her 349-bed hospital has cut its duplication rate in half and maintained an average duplication creation rate of less than 2 percent. Reducing registration errors was critical at Providence, which has nearly 60 points of entry.

This, says Kerlin, is typical. Many hospitals admit patients at radiology, lab and cancer centers, and use systems that are not directly connected to the hospital's overall ADT system. “So what happens is you have a lot of different data files out there with patient demographics and insurance information,” he says. “With a true EMPI, data is available electronically and serves as the master record for all the activity of a patient within the hospital.” And that, he says, should extend beyond the administrative department and into the clinical units.

At Children's Hospital, Leach says, “strong partnership between registration and HIM” at her 284-bed facility has been paramount to achieving a clean MPI. “That relationship has been critical to registering people with the right identity to begin with, and then in working through duplicates and un-combines to make sure the data for each patient is correct,” she says.

In addition to the main campus, Children's includes two emergency hospitals, three urgent care locations and nine specialty care clinics, all of which use the EMR from Verona, Wis.-based Epic Systems. The hospital is also rolling out the EMR to its independent community providers as part of the PedsConnect program. With so many providers sharing one electronic record, Leach says it is critical that patient information is authentic.

To that end, Children's has implemented two patient index systems - Chicago-based Initiate Systems' Interoperable Health and Epic's Identity EMPI - which she says help maintain a low error rate. Although Leach says the two solutions “work well in concert,” she believes Initiate's product has evolved, and says she is looking at how Children's can further optimize its use. “What I look for in these tools is the ability to identify key data elements and be able to match on them using weighted criteria - at least that minimum level of sophistication.”