University of California (UC) San Diego Health
University of California (UC) San Diego Health, the San Diego region’s only academic medical center, consists of three hospitals (UC San Diego Medical Center, Jacobs Medical Center and Sulpizio Cardiovascular Center) with a combined capacity of 808 beds. Dedicated to providing the highest quality patient-centered primary and specialty care, UC San Diego Health maintains a regional strategy integrating research, teaching and clinical care. Each medical complex supports acute inpatient care and a spectrum of outpatient primary and specialty medical and surgical services, including emergency patient care. Ambulatory clinics are located throughout the county.
With 8,900 full-time and per diem staff and physicians, UC San Diego Health discharges 29,200 patients annually, along with 77,603 emergency and 749,557 outpatient visits each year. It is one of five academic medical centers within the 10-campus University of California system, which comprises the fourth largest healthcare delivery system in California and trains nearly 50 percent of the state’s medical students and medical residents.
Challenge
To support its affiliated physician practices and the community it serves, UC San Diego opened access to its Epic EHR system through the Community Connect program. Epic’s Community Connect enables healthcare systems like UC San Diego to extend their EHR platform to independent practices and smaller community hospitals that were kept from implementing a robust system due to the financial impact or limited IT support. It provides all the software tools, system integration, support and training needed for the healthcare organizations to deploy the EHR software.
“For strategic reasons, we decided to leverage our instance of Epic to support our immediate community and the San Diego region and host ambulatory practices that perhaps couldn’t afford Epic or didn’t want to employ a large IT team, but still wanted to be able to enjoy the latest and greatest, from an EHR standpoint,” said Cassi Birnbaum, Director of Health Information Management and Revenue Integrity at UC San Diego Health. “We also wanted them to be able to leverage the tools that Epic offers for reporting population health analytics, and to be able to do all the mandated and comparative reporting that is required—and infuse it all with the best practices we can provide them.”
Access to Epic was also provided to UC Irvine, which needed to transition off its legacy platform but was concerned about cost, manpower and other resources it would need to dedicate to the change, said Birnbaum, adding that “there were a lot of opportunities with combining our IT shops and building on the great foundation that we were able to achieve at UC San Diego Health.”
However, the health system quickly recognized missing, but crucial, pieces of the EHR-sharing puzzle: the need to address the scale/scope of duplicate records in the source master patient indexes (MPIs) and the overlap population between the source and target. Both would soon be co-mingled as part of the clinically integrated network (CIN) formed and made possible by Community Connect. Addressing a large number of duplicates would have forced UC San Diego to beef up their HIM/IT resources, including adding full-time employees (FTEs) to meet its implementation deadlines.
“We have a whole [integration] team that addresses, supports and helps our new clinically integrated network partners do all of their design, build and validation work before going live on Epic,” said Birnbaum. “But we started to have some growing pains with bringing on so many partners all at the same time associated with MPI integration. While we did add some team members, we also identified that it just wasn’t scalable with what was in the CIN pipeline. It didn’t make sense for us to continue to add positions, especially in between [onboarding] partners. It really came out loud and clear with UC Irvine and the magnitude of trying to bring in all of their existing MPIs.”
While UC Irvine was “doing an amazing job” on their own, they were working to move 10 years’ worth of patient records into Epic. It quickly became clear that momentum wasn’t sustainable with their current HIM/IT team—especially because much of the transition depended on the MPI for loading their legacy electronic record and converting appointments. Thus, final implementation of the conversion of legacy data/records was going to be significantly delayed without the help of a trusted third-party.
“They were really under pressure, so I was very grateful that we were able to contract with Just Associates to assist with the MPI work for UC Irvine,” said Birnbaum, adding that there were other practices of varying sizes along with another major partner in the pipeline to join the network. “We were then able to leverage that relationship to help us with all the groups that have joined our clinically integrated network since then, because when we did the math, we found out that it really didn’t make sense for us to continue to add FTEs to manage ongoing MPI cleanup efforts.”
Solution
By engaging Just Associates to undertake a comprehensive cleanup of each partner’s MPI prior to deploying Epic and joining the clinically integrated network, UC San Diego had access to the industry’s leading data integrity experts. Just Associates also brought to the table IDManage®, the firm’s robust ongoing MPI support service (see sidebar), to support cleanup of each practice’s MPI prior to their integration into the network.
As each practice signs on to the network, Epic tools are used first to analyze the new partner’s records against UC San Diego’s full MPI to identify potential duplicates. Those are then loaded into the production instance of Epic, where Just Associates takes over to validate and resolve all of the true duplicates.
By working in the production versus test environment, the process of resolving duplicates is faster and more accurate because it eliminates the problems caused by the varying record keys unique to each database. Just Associates also leverages data from external, third party data sources to supplement information available from the partners and UC San Diego, which helps increase the prove rate of confirmed duplicates. However, knowing that third-party data and referential matching techniques are not 100 percent accurate, the data is used prudently, with strict QA protocols.
Just Associates uses its trained staff and a sophisticated workflow application to gain efficiencies that translate to a cost-effective solution—important to resource-strapped practices. The IDManage solution provides flexible staffing that can ramp up quickly when additional practices are brought into Epic. The total solution enables continuity of care to be provided more quickly to those patients whose records were duplicated between the organizations’ MPIs. It also helps minimize the risk of adverse events.
“This model works very well. It’s scalable and timely, in terms of being able to take a data load and turning it around quickly,” said Birnbaum. “Just Associates is our trusted source—our extra arm—for maintaining MPI integrity.”
Results
The most immediate impact was a significant acceleration in the time required to clean the MPI in preparation for the move to Epic. What once took three or more weeks was now taking just a few days for larger practices. Further, deployment of IDManage prepared UC San Diego to expediently address onboarding of any future practices into the network. The solution eliminates the need to staff up to handle duplicate cleanup and delivers highly cost-effective ongoing MPI maintenance.
“The ability to scale cleanup, to leverage the technology that they have to identify whether or not it’s a potential match, and the ability to work through thousands of duplicates in a very short period of time all contribute to the value realized from engaging Just Associates,” said Birnbaum. “The pricing model works for us as well as the partners, and we don’t have to worry about productivity levels.”
The data discrepancy reports provided by Just Associates also arm UC San Diego and the partner practices with the information they need to pinpoint where and how duplicates are entering the systems. This can then be used for targeted education such as helping the front-end staff improve registration processes.
“It lets us achieve our ultimate goal of reducing the creation of duplicates,” said Birnbaum.
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