Studies in Success: The Children's Hospital - Denver, CO

Rethinking Patient Identity Management

A new approach to common problems

 

About The Children’s Hospital: 

Founded in 1908, The Children’s Hospital in Aurora, Colorado is a renowned 314 bed, comprehensive pediatric care facility and Level 1 trauma center. With a bustling main campus, 15 network of care facilities, two emergency care and three urgent after hours care locations, it is at the forefront of research and medical breakthroughs.

Challenge: 

In 2007, The Children’s Hospital (TCH) became the first in the nation to implement a fully integrated pediatric EHR system. However, the new electronic environment exposed patient identity issues that have been hard to rectify. With Epic and Initiate plus approximately 70 additional systems on the back end, patient identity management at TCH has become a daunting task.

Melinda Patten, director of health information management, joined the hospital in March of 2009. She inherited a backlog of duplicate records and overlays that was more than her department could handle.
“[Patient identify management] is a very complicated process with many points of error,” shared Patten. “We wanted to get in best practice with managing the EMPI, because patient identity is very important to us.”

Adding to the urgency was the financial impact of patient identity errors to the hospital and its facilities. “One children’s hospital has estimated the cost of a record overlay at $400.00 per record, and that is charged back to the department that creates the issue,” said Patten.

Solution: 

TCH had one fulltime staff member dedicated to identity management issues and was looking for another line person to help. But Patten soon realized that the real solution would be found only in the prevention of new issues, so she changed the focus of her candidate search.

“I needed to find someone who could do the coordination, find out where the issues were, what they were, and understand if they could be resolved as an institution or if the problems were because of the various nationalities of customers and patients we serve. I wanted someone who could do more than just manage duplicates and overlays. . . someone who could review and establish processes and communicate to our network of care sites,” said Patten.

Patten decided to create an unprecedented EMPI analyst role, and found Eric Williams, a non-credentialed graduate student majoring in healthcare management to fulfill it. At the same time, she enlisted the help of Just Associates of Denver, Colorado, a trusted partner in healthcare data integration and data integrity consulting. Just Associates already had deep knowledge of TCH’s systems, and was uniquely positioned to provide Williams with comprehensive training in EMPI, validity models, statistical aggregation, problem solving, system algorithms, and HL7 messaging concepts. Just Associates also provided detailed insight into the COHRIO data model and requirements for information sharing as well as the different systems used by other health information exchanges.

Finally, Just Associates created a complete presentation and educational materials for Williams to use when providing future patient access in-service training. “We had worked with Just Associates [on previous EHR and EMPI projects] and we thought that it was really important that they knew us and understood us already, and we didn’t want to start over with someone else.”

Results: 

By all accounts, Patten’s instincts paid off. Williams spent some time observing the busiest shift in TCH’s ER, where he witnessed the patient registration process first hand. “I wanted to find out why the duplicates were occurring. Through research I found that there was a lot of human error, lots of misspellings of first and last names and transposed dates of birth,” said Williams.

Williams concluded that the majority of registration errors happen as result of the nature of emergency pediatric care. The hectic volume of patients with urgent and non-urgent medical needs, combined with cultural differences often result in a convoluted registration process. “We really are different here because mom and dad don’t always bring the child in. Sometimes it’s the grandparent or someone else. They don’t always know the child’s social security number and addresses. These pieces of information help us match the correct child to the correct medical record. And often the child doesn’t have a social security number, and they aren’t always from this country,” said Patten. Added Williams, “I probably witnessed at least 6 times where the child translated for the parent. The language barrier creates a big challenge and there are a lot of opportunities for mistakes.”

With a better understanding of process and the expertise of Just Associates, Williams made key modifications and improvements to TCH’s existing Duplicate Medical Record Number Report, providing actionable information to supervisors for the first time. This report enables supervisors to quickly identify errors made by their teams, pinpoint the individual responsible for each error and see the date in which the error was made.

Now Williams provides customized training to specific supervisors and offending individuals, ensuring that everyone understands the impact of common mistakes and how to prevent them. Williams also created and distributed a naming conventions reference sheet to remind registrars of best practices. The result of his efforts was almost immediate. “We have seen a reduction in our duplicates for the first time in 8 quarters… a reduction of almost 10%” said Williams.

Williams attributes much of his success to the training he received from JA. “Training from Just Associates was excellent. It gave me a foundation - a broader understanding of patient identity. It allowed me to come up with a game plan to tackle duplicates and overlays, and I used the training materials to train the ER registration staff and that went very well.”

Williams plans to implement more process improvements and looks forward to spending the next few months educating the rest of TCH’s registrars on best practices. What’s more, he and Patten expect to see continued reductions in patient identity issues as a result of TCH’s new patient identity management strategy.

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