Effectively managing patient information can be a challenge for one hospital, let alone an entire network, but few providers have had to tackle the type of challenge faced by New Orleans-based Ochsner Health System.
Ochsner, the largest private health system in Louisiana, saw its patient population dispersed across the state and the country after Hurricane Katrina hit the region in 2005. As residents returned to the area, many had new addresses and sought care at new facilities, making it difficult for registration staff to match the right patient with the right record. Ochsner also acquired three New Orleans community hospitals, and needed to merge these new patient records with its existing files.
Ochsner wanted a robust enterprise master patient index (EMPI) to eliminate duplicate records, and improve its patient search capabilities. The health system hired IBM (Armonk, N.Y.) to implement Initiate System's Patient EMPI solution across its network in 2007, and has since weeded out hundreds of thousands of duplicate records, and improved its registration processes.
“This was huge for us,” says Chris Belmont, assistant vice president of corporate information systems at Ochsner. “In post-Katrina New Orleans, our population is very dynamic. With this system, we can map their new information with our old medical records.”
An EMPI maintains unique listings of patients and medical records across multiple facilities and hospitals, and utilizes complex search algorithms based on several search fields to ensure staff can find the correct patient record and avoid creating duplicate records.
For hospitals, duplicate records aren't just a minor record-keeping inconvenience. If a patient's medical information is spread across separate records (or combined with another patient's information), care could be negatively affected. EMPIs can eliminate duplicates, and improve registration and scheduling efficiency. Accurate patient data is also an important part of EMR adoption and HIPAA compliance, and can improve data sharing capabilities as hospitals and provider networks consolidate.
According to the HIMSS Foundation, in 2005 approximately 26 percent of hospitals had installed EMPI software or signed a contract to do so. Interest in these systems is increasing as hospitals join larger provider network and regional health information organizations (RHIOs).
“RHIOs are bringing together not only acute care and ambulatory sites, but pharmacies and payers as well,” says Paul Pitcher, research director at KLAS Enterprises (Orem, Utah). “Those environments are very complex. How do you bring all of this information together in a way that enables you to share a common patient record?”
EMPI solutions are typically purchased along with other health information systems from large vendors like McKesson (San Francisco), QuadraMed (Reston, Va.), and Eclipsys (Atlanta). That was not the case at Ochsner Health System, however. Ochsner's Initiate EMPI is integrated with the hospital's Invision system from Siemens Medical Solutions (Malvern, Pa.), McKesson's Horizon Patient Folder and a homegrown data repository.
“Although we've been a Siemens shop for the better part of 25 years, we did not want to stick with a pure Siemens platform,” Belmont says. “We wanted to be able to couple the system easily to non-Siemens products.”
Belmont says Ochsner's HIM and business services staff were involved in evaluating the solution. The group was under a tight deadline because the system had to be up and running before the first of the acquired hospitals came online in the fall of 2007.
“IBM helped us connect all the dots,” Belmont says, adding that the integrator helped Ochsner avoid several potential implementation mistakes. “One big piece we would have missed was the systems integration piece. We didn't appreciate how difficult it was going to be to integrate the EMPI with Invision.”
Hackensack University Medical Center, a 781-bed teaching and research hospital in Hackensack, N.J., also faced an integration issue when it wanted to embed Reston, Va.-based QuadraMed's EMPI product with its Tempus Software scheduling system. Working directly with the vendors, the hospital has improved its scheduling processes and reduced duplicate records. (QuadraMed acquired Tempus in 2004.)
Staff can access the EMPI via the scheduling system, and color coding helps indicate the best records match. “It has really improved operational flow,” says Alan Leipsner, manager of ambulatory scheduling. “You can select the right patient, and pull up the most accurate information. We can more accurately and efficiently speak with the patients as we're scheduling them.”
A major part of an EMPI deployment is evaluating and merging duplicate patient records. This is no easy task, and can require a significant investment in money and manpower — many hospitals generate several thousand duplicate records per month, with the average cost to merge them manually running between $8 and $10 each, along with thousands of employee hours. Hospitals often ask EMPI vendors to help manage the process (special software tools can halve the time it takes to merge duplicate records), as well as hiring temporary staff to help the HIM department evaluate the records.
Ochsner's duplicate records problem immediately became apparent during the data cleansing process. Of the initial 2.7 million entries in the system, there were more than a quarter million duplicates, as well as thousands of other entries that required investigation.
Once the data is clean, policies must be implemented to prevent creation of additional duplicates. Registration staff must follow clearly established policies regarding the demographic data collected for each patient, which search fields to use, and what clarifying question to ask patients during registration.
“We've had to get people comfortable with this new way of searching,” Belmont says. “You have to be more specific with the search now. Of course, the registration people are saying, if this system is better, why do you need more information? Once you explain that the old way caused us to have 260,000 duplicates, they finally get it.”
As with most data management systems, an EMPI is more of a journey than a destination, and includes ongoing subscription, integration and maintenance costs. EMPI systems generally require tweaking to adjust the weight given to each search field to improve the accuracy of the searches.
Integration with other information systems can also be complicated. Even though IBM smoothed out this process at Ochsner, there have still been challenges. Coded values (particularly insurance codes) for disparate systems, for example, don't transfer easily through the EMPI.
For other health systems considering an EMPI implementation, Belmont emphasizes that IT staff should not underestimate the potential integration hurdles with disparate information systems, or the volume of patient records.
“We originally contracted for 2.5 million entries, and we entered 2.7 million,” he says. “Since then, we've purchased a hospital in Baton Rouge, so we're upping our entry limits. If I could do it all over again, I would spend more time scrubbing the data and finding a way to either eliminate the coded values or convert them. That would have given us more time to spend on the user-adoption part.”
Once everything is running smoothly across all facilities, Belmont hopes to utilize the software for marketing, physician master files, and even employee files. “Searching for a physician isn't any different than searching for a patient,” he says.