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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.”

(Inter)face time

Where EMPI solutions can get complicated, according to Kerlin, is in speaking to other IT systems. He says stand-alone solutions that require interfacing with existing systems present the biggest challenge. “The problem comes when you have an organization that has Siemens and McKesson and Meditech for different applications, and their systems don't work very well if they're not the main repository of that data. There's a lot of complicated integration or interfacing that has to happen.”

“As you pull together an EMR, I like to think of it like the human body. The EMPI is one of those critical organs that needs to be strong, and needs to be pumping healthy information to the rest of the brain and the rest of the body.”

At Providence, QuadraMed's SmartID was initially tied to the Siemens' Invision clinical documentation system to help ensure accuracy of patient information throughout the Malvern, Pa.-based vendor's Enterprise Access Directory. Building the interface, says Hyde, laid the foundation for data sharing with ancillary systems that would be rolled out later, including Alpharetta, Ga.-based McKesson's Pathways Healthcare Scheduling system.

“As you pull together an EMR, I like to think of it like the human body,” she says. “The EMPI is one of those critical organs that needs to be strong, and needs to be pumping healthy information to the rest of the brain and the rest of the body. If you don't have a good way to present the data you've collected electronically, then not only are you going to fall short on not having all the patient's information, but you can't even present it in a logical, readable fashion.”

Ticket to an HIE

In addition to serving as a key building block for an EMR system, an effective MPI can also position an organization for information exchange initiatives. Although Providence doesn't currently participate in a statewide health information exchange (HIE), the hospital has begun discussions with other organizations to establish data sharing in the state of Alabama, says Hyde, and having the correct identification for each patient is critical.

The Children's Hospital is involved with two information exchange programs - Colorado RHIO (CORHIO), which went live in January 2010, and Care Everywhere, a three-way partnership with Kaiser Permanente (Oakland, Calif.) and Exempla Healthcare (Denver), according to Leach. And this level of data sharing, she says, requires a highly-functioning MPI. “If we're sending over potential duplicates, they won't even pass through into the exchange,” she says. “A clean patient index, whether you use a homegrown MPI tool or a vendor EMPI, is the ticket to admission to an HIE.”

One trend that could impact both HIEs and hospitals going forward is the increased number of vendor products available, many of which Leach says are embedding the Initiate EMPI. “When we started our RHIO five years ago, there weren't any vendors. We co-developed with Sun Microsystems (Santa Clara, Calif.) and now we're re-evaluating and looking at the vendor community for a longer-term solution, and the EMPI function is a critical part of that.”

As the industry surges ahead with electronic records, the integrity of patient data is only going to become more vital, and the onus is on CIOs to make sure data is not only correct, but also usable, Hyde says. “The challenge we have with a master patient index is how good or how bad a shape is it in and can you monitor it on a day-to-day basis. And if you can't, then you need to think through a strategy to really investigate what is the health of your MPI.”

Healthcare Informatics 2010 January;27(1):22-26

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