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Studies in Success: Jefferson Radiology and IDManage®

Outsourcing Ongoing MPI Management Ensures Data Integrity and Enables Effective Health Information Exchange for Jefferson Radiology



With approximately 1 million patient records flowing through its systems annually, data integrity is integral to virtually every aspect of clinical and administrative operations at Jefferson Radiology (Jefferson). One particular area of focus is its Master Patient Index (MPI), where duplicate and overlaid records could negatively impact both patient safety and regulatory compliance.

"We really focus on the MPI because of the potential risk -- if you were to erroneously merge two patients' records, you'd actually be merging their clinical histories, which could then lead to inappropriate disclosure of protected health information if that merged information got passed along," said Michael Quinn, Chief Technology Officer, Jefferson Radiology. "Also, if that improperly merged clinical history went to the reading radiologist, it could impact the accuracy of the clinical decision because they had the wrong history."

As with most healthcare institutions, Jefferson was diligent in auditing and logging to ensure records were merged correctly. However, Quinn took the opportunity to raise the bar when the group began planning implementation of a new radiology information system (RIS). If "dirty data" is migrated to the new system, it can potentially create a domino effect that would impact downstream clinical and financial systems. While Jefferson was vigilant about its existing system, it still knew it didn't want to take that type of risk. 

To avoid it, as part of the system transition, Jefferson Radiology needed a higher level of auditing and cleanup of its MPI than it could deliver with its limited resources and expertise.

"We looked at doing this internally, but realized that it was not our area of expertise. We might make mistakes that could turn it into more of a negative than a positive," Quinn said. "So we decided to turn it over to someone who understood, was a leader in the area and would know exactly what needed to be done and when."

That "someone" was Just Associates. Jefferson Radiology engaged the firm to conduct an analysis to identify the scope of any potential problem and then eliminate it. Ultimately, Just Associates identified a duplicate rate of about 3% and proceeded with an MPI clean-up. 

To protect its newly clean MPI, Jefferson wanted to improve its process for preventing the creation of future duplicates and overlays and for eliminating any that were still able to sneak in. As with the initial clean-up, the practice's limited resources and a lack of specific expertise meant internally managing the MPI on an ongoing basis would be a challenge.

Jefferson Radiology once again turned to Just Associates for its ongoing MPI management service, IDManage®. 


With IDManage outsourced MPI management, Jefferson Radiology gained around-the-clock access to Just Associates' patient identity management experts, who are thoroughly trained and dedicated to the efficient validation and eradication of duplicate records. Through ongoing monitoring, IDManage prevents new duplicates from entering the RIS and identifies other issues with the potential to negatively impact data integrity. 

Importantly, this frees internal staff to focus on their core competencies "while the Just Associates' team focuses on theirs, which is the ability to work through identity management issues," said Quinn. "That's a significant value because in healthcare, protecting patient information and access is critical. Knowing that we have an additional level of robust safeguard in place has been one of the biggest advantages for us."

With IDManage, Just Associates' experts are alerted to potential duplicates. They then access the system remotely, validate and merge true duplicates. Records lacking sufficient information to determine whether or not they are duplicates, or those with other potential data integrity problems requiring further research, are manually addressed by the client.

To ensure the highest level of accuracy, all IDManage processes are subjected to a rigorous Quality Assurance protocol. All staff decisions regarding the validity of a possible duplicate are reviewed by the Just Associates' quality assurance team, creating a two-tiered review of all validity decisions before action is taken.

As Jefferson Radiology's needs have changed, so too have the services provided under IDManage. For example, when the practice upgraded its RIS, Just Associates' experts quickly became proficient on the new platform, enabling them to efficiently address the spike in potential duplicates created by the data migration. With the advent of electronic records and interoperability, the practice has also expanded the number of hospitals with which it exchanges data, which subsequently drives up the number of potential duplicates that could compromise the integrity of its MPI data. These periodic spikes in duplicate volume are easily handled by the flexible staffing model which is one of the benefits of IDManage.

Another change is addressing the data integrity needs behind Jefferson Radiology's recently launched patient portal—a requirement under Stage 2 of the Meaningful Use program. When a patient registers to use the portal, their identity must be validated. Any discrepancy, including identification of more than one possible record for the registrant, can delay validation and issuance of login credentials. Delays in clearing the discrepancy and issuing login credentials can lead to patient frustration and thwart the purpose of the portal. Thus, it was important that discrepancies be resolved quickly. 

In fact, outsourcing MPI management to Just Associates and IDManage gives Jefferson Radiology a head start on demonstrating Meaningful Use that goes beyond eliminating obstacles to patient portal access. By keeping its MPI free of duplicates that can artificially inflate unique patient numbers, IDManage helps get Jefferson Radiology closer to compliance with several Meaningful Use criteria that are based on percentage of unique patients.

Quinn notes that data integrity will also play an important role in any success Jefferson Radiology realizes from future participation in a number of emerging initiatives, such as population management. 

"There are certain demographics that are required for population health so it's important to know that the data is correct, even if that information is ultimately de-identified" he said. "You have to ensure it's the correct patient. There has to be a number that is tracking to that patient, and you have to be able to share that number or be able to integrate them, even if you have multiple MPIs."


Since outsourcing its ongoing MPI management to Just Associates and IDManage, Jefferson Radiology has been able to maintain its duplicate rate well below 1%. The few duplicates that do trickle into the system are identified, validated and resolved within 24 hours, greatly reducing the potential for compromising patient safety and care. 

The ability to maintain clean records is crucial for patient safety. In particular, radiologists retrieve prior studies for comparisons. Patient identities are also often searched and verified based on the existence of similar procedures in their record, which means that having the correct patient information facilitates better matching prior to retrieval and better care.

"It takes a lot of resources to maintain MPI data integrity. We simply don't have the staff, expertise or ability to do it ourselves," said Quinn. "The real value of Just Associates is that they make it possible for our staff to focus on core competencies because their consultants are focusing on working through identity issues. In healthcare, that's very important. It's been a big advantage for us." 

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