Just Associates also looked at how the SSN was entered into the registration and scheduling systems and sent to all downstream, clinical, ancillary, and financial systems and whether downstream systems utilized the patient identifier within their databases as a primary record key. The final piece to this process was determining how the systems read inbound message transactions and utilized the SSN to determine whether the transaction should add a new record or update an existing one.
Throughout this process, extensive interviews were conducted with the integration team and members of each department that utilized systems impacted by the patient identifier. By understanding exactly how the identifier was used, Just Associates was able to develop a workflow process that traced the movement of the patient identification number from entry point (registration) through exit point (discharge) and every possible formation in which that number would reside (paper files, electronic spreadsheets, etc.).
The impacted systems were then ranked according to specific risk levels. This led to the development of a strategy for conversion with specific recommendations for approaching conversion within each system.
IMPLEMENTATION AND BENEFITS
The detailed mapping and strategy process made it possible to effectively design and run software scripts to automate conversion to the MRN system. Just Associates developed scenarios for error trapping and for identifying potential failure points to ensure a smooth process and minimal disruption. The firm also established estimated timeframes for executing the conversion process, established audit logs to track progress in downstream systems and set quality assurance and error thresholds.
That, coupled with a carefully planned strategic approach, has kept the project moving forward. In August 2010, PRMC went live with the use of MRNs in all 25-plus applications. There were minimal disruptions to clinical systems and departments-even in the midst of a deployment of a new clinical information system.
EXTENSIVE INTERVIEWS WERE CONDUCTED WITH THE INTEGRATION TEAM AND MEMBERS OF EACH DEPARTMENT THAT UTILIZED SYSTEMS IMPACTED BY THE PATIENT IDENTIFIER.
This unique approach resulted in significant savings of both costs and resources. In addition to reducing the IT staff's workload, it also reduced workloads in the impacted clinical and ancillary departments. The need to bring in additional temporary staff was minimized.
Equally important, developing and running test scripts to confirm conversion accuracy helped ensure system-wide confidence in the project. PRMC and its patients also benefit from heightened security, as well as improved compliance with HIPAA, Maryland's Personal Information Protection Act (PIPA), and federal Red Flag Rules.
Overall, the migration to a new medical record numbering system was conducted in an efficient and cost-effective manner, and the conversion process helped PRMC gained a better understanding of how data and information flow through the entire organization. This is proving to be invaluable as the facility continues its migration to a new information system.
Gwyndle Kravec, MBA, RHIA, CCS, is the health information management privacy officer for Peninsula Regional Medical Center ( www.peninsula.org). She has been in the health information management field for 23 years. She can be reached at gwyndle.kravec@peninsula.org. Healthcare Informatics 2011 August;28(8):49-51
