UW Medicine Leverages Just Associates’ Experts and IDManage to Achieve a Unique Epic Enterprise ID
Seattle-based University of Washington Medicine(UW Medicine) was working toward the establishment of a unique Epic Enterprise identifier for each of the nationally recognized academic health system’s patients. To do so, it would need to move its community hospital, Northwest Hospital, onto the same Epic registration system that was in place at its flagship facilities, UW Medical Center and Harborview. But first, it would need to clean up its Epic master patient index (MPI), removing duplicate medical records to prevent damaging the integrity of the merged databases.
According to Sally Beahan, RHIA, MHA, Director of Health Information Management (HIM) for UW Medicine, the MPI cleanup would also benefit the health system’s participation in several Accountable Care Networks (ACN) by ensuring the data it shared was pristine. “We needed to identify any [duplicates] that already existed in our system, so they could be merged and the MPI integrated as much as possible.”
UW Medicine turned to the patient data integrity experts at Just Associatesfor the project, which entailed providing files of confirmed duplicate pairs to be reconciled in Epic and marking confirmed false positive matches as known non-duplicates. The health system also deployed IDManage®, Just Associates’ robust ongoing MPI support service, to resolve any duplicates created in the merger’s immediate aftermath, as well as to support cleanup of ACN records prior to their integration into its main MPI.
The initial review of more than 31,000 possible duplicates was conducted using data elements from UW Medicine’s Epic system supplemented with external third-party data sources, which “can result in a higher prove rate of confirmed duplicates but third-party data is not 100 percent accurate and must be used prudently, with strict QA protocols,” cautions Just Associates CEO Beth Just. “Our patient identity experts also perform supplemental research on pairs requiring additional information to validate whether the record was a true duplicate.”
Just Associates’ experts confirmed and resolved approximately 23,400 records as either duplicate or non-duplicate for a prove rate of 75 percent. The remaining 25 percent had insufficient information or data integrity issues, or they required additional research before they could be validated—a rate significantly higher than the 10-20 percent normally seen by Just Associates’ experts.
Demographic update files were provided for key elements on confirmed duplicate pairs for updates in Epic after the batch merge processing. Just Associates also determined best practices related to record matching within the health system’s MPI. UW Medicine had been generally utilizing the out-of-the-box settings for Epic’s matching algorithm, with some adjustments.
“Unfortunately,” notes Just, “the basic or intermediate algorithms within most EHRs rely primarily on deterministic matching, which can result in an unacceptably high number of false alarms and, more importantly, false negatives.”
Understanding more about the patient matching algorithm was “one of the huge benefits of this project…we looked to Just Associates to provide expertise from a best-practice perspective on whether our current settings were right for us,” said Beahan. “We [also] benefited from seeing through IDManagewhere the issues were coming from, identifying the duplicates and the issues that were creating the duplicates.”
That knowledge coupled with the actionable business intelligence reports provided by Just Associates helped inform Beahan’s strategy and planning for keeping duplicate rates under control. This included turning on new functionality in the Epic system that allows end users to mark merges or potential duplicates.
Even with that, however, it is an uphill battle to dedicate the appropriate resources to the problem. “…We have a hard time keeping up with the staffing level we have,” Beahan explained, “…so we are looking to implement IDManage on an on-going basis because the service combines Just Associates’ technology and trained staff. The efficiencies they bring are definitely beneficial.”
She continued, “If I can reduce staff time [spent] manually looking up and matching records and use IDManageto do that work more efficiently, I can re-direct my staff to work the really tricky [pairs] left over. It would also free up staff to work on overlays and overlay corrections which are very tedious.”