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Customer Quotes:
"A solution had to be obtained quickly to keep the implementation team from converting corrupt data in to the new data base. Just Associates responded quickly to our call for assistance…"
Karen Clark, System Director, Health Information Management, CHRISTUS Health - Houston, TX
"It's one thing to fix the duplicate patient records that are easy to spot while leaving the rest for the client to resolve, like some vendors. It's another to address those records that are nuanced and complex. Just Associates does both."
Belinda Walter, RHIT, Health Information Manager, Cascade Healthcare Community - Bend, OR

Data Integrity Matters Newsletter: March 2011 Vol 1

Welcome to the premier edition of Data Integrity Matters, an informative newsletter from Just Associates designed to keep you up-to-date on the latest trends in data integrity, health information management and health IT. We'll also share information on regulatory and industry changes that impact how health information is collected, stored, shared and utilized to improve the quality and safety of and access to healthcare and how those changes can affect a provider organization's bottom line.

In each issue you will find two feature articles focused on key issues, trends and challenges surrounding the health information management (HIM), health information technology (HIT) and data integrity space. In this inaugural edition, we take a closer look at the impact duplicate patient records have on achieving meaningful use, as well as on the changing role of HIM in today's technology-driven healthcare environment.

Each issue will also include the following:
• Around the Industry: a roundup of significant industry developments, including new regulations, recent surveys and research and association news.
• Inside Information: surprising or unusual factoids about processes and software used by hospitals, physicians and other providers, including functionality tips and hints and unique statistics.
• Executive Viewpoint: a place for Just Associates executives to share our insights into current issues or trends.
• Just News: information to keep you up-to-date with all things Just Associates.
All of us at Just Associates hope that you find Data Integrity Matters to be informational and useful to your current and future operations. We hope that you share our excitement in this opportunity to keep you abreast of industry trends and issues.
Duplicate Records Can Delay Meaningful Use
Duplicate patient records have long been a serious problem for hospitals, creating the potential for life-threatening care situations due to missing or inaccurate patient information. They also place a significant burden on financial, health information management (HIM) and IT resources.

The burden created by duplicates is even greater for facilities wishing to qualify for incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act - payments that start at a base of $4 million for those hospitals that qualify under both the Medicare and Medicaid programs and increase based on additional factors such as total inpatient discharges and Medicare share.

That is because many of the Stage One qualifying criteria are tied to a percentage of unique patients. For example, one criterion is that 80 percent of patients must have a problem list within the electronic medical record (EMR) in a structured data format. The presence of duplicate records artificially inflates this number, making it increasingly difficult for hospitals to demonstrate meaningful use.

Duplicates and Meaningful Use

How much more difficult depends on the volume of duplicates. Industry estimates place the duplicate record volume at a typical hospital at 3 percent to 15 percent. For hospitals that are part of integrated networks or that have been acquired by or merged with another facility, the average duplicate volume rises to 30 percent and higher.

Thus, if a hospital has 1 million patient records in its system, 10 percent of which are duplicate, it would be required to have a problem list for 800,000 patients to achieve meaningful use. If those duplicates were eliminated, problem lists would be required for just 720,000 patients. If that same hospital has a 15 percent duplicate volume and those duplicates were resolved, problem lists would be required for just 680,000 patients.

The same holds true for any of the criteria where percentage of unique patients is the denominator. These include medication and medication allergy lists recorded as structured data for 80 percent of unique patients and demographic data for 50 percent.

Eliminating duplicates eases the meaningful use burden by reducing the number of records against which the criteria are weighed by potentially hundreds of thousands. It also eliminates a significant financial drain, including 20 percent to 30 percent in additional clinical and treatment costs when inaccurate or missing information results in repeated diagnostic tests.

The problem is that reconciling and eliminating duplicates is a cumbersome, manual process that requires staffing resources most hospitals cannot spare. What's more, these manual processes do nothing to prevent future issues.

Automation to Achieve Meaningful Use

By automating portions of the reconciliation workflow, hospitals are able to quickly and efficiently weed out existing duplicates and prevent the creation of new ones. Automating high-level processes also supports merging records in downstream systems while reducing manual steps and associated costs.

Specifically, automation allows for the review of multiple duplicates in a single view. It also heightens user control over the merge process, lessens the time required to complete the process and enables more effective quality assurance before records are merged.

To accomplish this level of automation, a growing number of hospitals are turning to IDMasterTM from Just Associates. Customizable to match an organization's unique review processes, IDMaster supports the steps involved in identifying and validating possible duplicates and multiples. It enables the insertion of checkpoints for quality assurance, tracks and documents each step in the workflow and features productivity tracking by individual and an audit log that records errors and corrections to drive improved performance.

The software requires little or no IT support. Its web-based deployment allows for quick implementation and features import functionality that supports most hospital information systems and/or third-party data analysis capability.

One hospital system is utilizing IDMaster to automate its workflow processes, allowing it to resolve more than 500 duplicate records monthly at each of its three facilities using fewer resources than had previously been dedicated to the process. It is a level of productivity that hospitals need to ensure that they reduce the number of duplicate records within their organization to more efficiently meet criteria for meaningful use to receive HITECH incentive funds.
Health Information Management's Evolving Role
Passage of the American Recovery and Reinvestment Act of 2009 (ARRA) has driven demand for skilled professionals in the areas of electronic health record (EHR) implementation, quality measurement and reporting, and privacy and security to an all-time high. Further, health information management (HIM) professionals are well-positioned to coordinate and serve as the core foundation to support a facility's needs under ARRA.

The Children's Hospital (TCH) In Aurora, Colo., is an excellent example of how HIM's role is transitioning under ARRA. Shortly after becoming the first hospital in the nation to implement a fully integrated pediatric EHR system, TCH recognized that HIM's unique skill set was necessary to uncover and prevent identity management issues in the new electronic environment.

I wanted someone who could do more than just manage duplicates and overlays ... [I wanted] someone who could review and establish processes and communicate to our network of care sites," said Melinda Patten, TCH's HIM director.

To do this, TCH created the position of enterprise master patient index (EMPI) analyst, a role that was filled by Eric Williams. TCH also enlisted the help of Just Associates to provide Williams with comprehensive training in EMPI, validity models, statistical aggregation, problem solving, system algorithms, and HL7 messaging concepts.

That training and guidance helped Williams quickly recognize that the key to preventing creation of new duplicate records lay in uncovering why duplicates were occurring in the first place. His research revealed that the primary culprits were registration errors, such as misspelled names and transposed dates of birth, many of which were the result of the chaotic nature of emergency care in a multicultural environment.

To resolve the issue, Williams made key modifications and improvements to TCH's existing duplicate medical record number report that enabled supervisors to quickly identify errors, who made them and when. Williams also designed customized training that helps ensure everyone understands the impact of common mistakes and how to prevent them.

The result of his efforts was almost immediate.

"We [saw] a reduction in our duplicates for the first time in eight quarters ... a reduction of almost 10 percent," said Williams, adding that the training provided by Just Associates was invaluable. "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."
Insider Information
Did you know that within Siemens' INVISION® Clinicals, the Duplicate Enrollee Workstation and Duplicate Enrollee Report (DEWDER) application assists in identifying and managing duplicate records? The algorithm that produces duplicate reports builds on the sophisticated matching algorithm (SMA), resulting in an application that is more tolerant of data discrepancies than deterministic "exact match" routines. This is important as half of all duplicates have data discrepancies in key demographic data fields including Name, Date of Birth, Gender and Social Security Number.

DISCLAIMER: This newsletter is for informational purposes only and should not be interpreted as a commitment of accuracy on the part of any company named herein. Just Associates believes the information to be accurate at the date of publication, but makes no guarantee. All company and product names used are trademarks of their respective owners.
Around the Industry
Study Reveals EHR Cost per Physician

An ambulatory practice's cost of adopting an EHR system could reach $120,000 per physician, 84 percent of which comes from lost revenue because of fewer patient encounters during the transition. That's according to a recent study from CDW Healthcare, which also found that the quicker a practice can adapt to new processes and workflows, the greater the financial reward will be. A shorter adoption timeline may also lessen lost revenues. Further, once fully adopted, EHR systems could increase the number of patients seen by up to 15 percent, bringing in $151,000 in additional revenue per physician, per year.

CPOE Is Top Clinical Priority for CMIOs

Computerized physician order entry (CPOE) also is the top clinical IT priority for CMIOs for 2011, according to a survey of CMIOs who attended the recent "CMIO Summit: The Key to Successful Meaningful Use," hosted by CMIO Magazine, the Association of Medical Directors of Information Systems (AMDIS) and CMIO Advisors. Just behind CPOE (44 percent) is systems integration and interoperability (31 percent), and electronic medical record (EMR) and electronic health record (EHR) implementation (25 percent).

ONC Names Additional EHR Certification Bodies

The Office of National Coordination for Health Information Technology (ONC) has designated ICSA Labs and SLI Global Solutions as ONC-Authorized Testing and Certification Bodies (ONC-ATCBs), authorized to test and certify complete EHR and EHR modules. They join the CCHIT, Drummond Group and InfoGard Laboratories, which were recognized as ONC-ATCBs last year.

CMIO 2010 Compensation Survey Results

Chief medical informatics officers (CMIOs) are generally satisfied with compensation and happy with their career choice, according the CMIO Magazine's 2010 Compensation Survey. In terms of dollars, identified salaries ranged from less than $30,000 to more than $300,000, with 48 percent reporting an annual earnings of $200,000 or more.

2011 Health IT Forecast

Health politics, a hyper-market for health IT; health-engaged consumers; and privacy ambiguities are all forecast to be players in the 2011 health IT industry, according to Jane Sarasohn-Kahn's annual health IT forecast for iHealthBeat. Sarasohn-Kahn also predicts that 2011 will bring stiff competition for skilled health IT workers in the wake of ONC estimates that hospitals and physician offices will need an additional 50,000 employees in the next five years to meet meaningful use criteria. Also at play will be the use of health data standards, which will pave the way for interoperability among IT applications and further the journey toward data liquidity.

Spending on Health IT Most Significant Industry Trend

Federal government policies will make investments in health IT the most significant issue in the healthcare industry in 2011, according to a report by the PricewaterhouseCoopers Health Research Institute. According to "Top Health Industry Issues of 2011," healthcare providers will implement or expand their health IT systems because of three policies: (1) the 2009 economic stimulus package and qualifying for payments under the Medicare and Medicaid incentive programs; (2) the transition to ICD-10; and (3) expected FDA regulations on how to report adverse events caused by medical devices. The report also suggests that an increase in health IT spending could lead to more mergers and acquisitions in the coming year.
Just Associates News
Just Associates Unveils IDMaster®

Just Associates is pleased to announce the release of IDMaster, an innovative software solution designed to optimize workflow when reviewing and validating potential duplicate patient records. The official unveiling took place at the 82nd AHIMA Convention and Exhibit, which was held in Orlando, Fla., Sept. 25-30, 2010.

Providing hospitals, health systems and other provider organizations, as well as health information exchanges (HIEs) and regional health information organizations (RHIOs), with an efficient and affordable means of reviewing and resolving duplicate patient records, IDMaster simplifies the process and reduces the resources required to reconcile potential duplicate pairs. It also prevents the occurrence of new data integrity issues by identifying problem areas.

Further, IDMaster documents the validity of decisions made regarding duplicates, tracks productivity and generates comprehensive, user-friendly reports that provide a complete view of efforts and key insights into problem origination points. It is also customizable to match the organization's unique review processes. For more information about IDMaster, visit IDMaster Software

Just Associates Partners with Ability Network

Ability Network (formerly VisionShare Inc.) and Just Associates have partnered up to offer a comprehensive, cost-effective master patient index (MPI) management solution designed to assist hospitals in resolving MPI data issues. Ability Network, the nation's largest secure health information network, will utilize its network services to identify potential duplicate records, and Just Associates will manage verification and cleanup. As a result, the firms are able to provide hospitals with accurate, complete and consistent data, while giving health information management (HIM) departments the tools they need to maintain a high-integrity MPI.

Beth Just Featured at Leading Industry Conferences

Just Associates President and CEO Beth Just shared her insights on the impact of the Health Information Technology for Economic and Clinical Health (HITECH) Act on HIM during a presentation entitled "Changing the Face of HIM through HITECH" at the 82nd American Health Information Management Association Convention in September. She was also a featured speaker at the International Federation of Health Records Organizations in Milan, Italy, in November, where she and Exempla Healthcare co-presented "Data Stewardship: Key to Building Transparency and Trust in the EHR."

New Faces

Just Associates is pleased to welcome Terry Richardson, RHIA, to the team. As chief privacy officer and project manager, Terry will be responsible for overseeing the firm's privacy and security consulting services.

2011 Health IT Forecast

Health politics, a hyper-market for health IT; health-engaged consumers; and privacy ambiguities are all forecast to be players in the 2011 health IT industry, according to Jane Sarasohn-Kahn's annual health IT forecast for iHealthBeat. Sarasohn-Kahn also predicts that 2011 will bring stiff competition for skilled health IT workers in the wake of ONC estimates that hospitals and physician offices will need an additional 50,000 employees in the next five years to meet meaningful use criteria. Also at play will be the use of health data standards, which will pave the way for interoperability among IT applications and further the journey toward data liquidity.

Spending on Health IT Most Significant Industry Trend

Federal government policies will make investments in health IT the most significant issue in the healthcare industry in 2011, according to a report by the PricewaterhouseCoopers Health Research Institute. According to "Top Health Industry Issues of 2011," healthcare providers will implement or expand their health IT systems because of three policies: (1) the 2009 economic stimulus package and qualifying for payments under the Medicare and Medicaid incentive programs; (2) the transition to ICD-10; and (3) expected FDA regulations on how to report adverse events caused by medical devices. The report also suggests that an increase in health IT spending could lead to more mergers and acquisitions in the coming year.

Just Associates in the News

Beth Just shared with readers the importance of including downstream systems in ICD-10 system audits in her Executive Insights article, "Transitioning to ICD-10." She was also quoted as part of a Health Data Management feature, "HIM's Role in Getting Meaningful Use Incentives."

Over the past quarter, Just Associates has also been featured in Healthcare Finance News, Healthcare Technology Online, FierceHealthIT, Health Data Management, Healthcare IT News and infoTECH.
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Just Associates, Inc. Provides MPI Clean-Up Services, Including Cleaning Duplicate MPI Records.
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