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Data Integrity Matters Newsletter
August 2012


Just Associates: Reflecting on 10 Years of Success, Transformation

By Beth Haenke Just

Just Associates launched in April 2002, a time when few others realized just how important data integrity would become as healthcare’s reliance on electronic patient information grew. Back then, electronic master patient index (EMPI) systems were just beginning to appear. Clinical information system (CIS) vendors and their customers were only vaguely aware of how limited the impact of these systems would be if the records imported into EMPIs were riddled with duplicates, overlays and other errors.

These early systems also lacked any sophisticated algorithms or other capabilities to accurately match inbound data from sources such as lab, radiology and electronic medical record systems. Instead, they relied on fairly standard interface engines to perform these complex processes — all but guaranteeing an error-riddled MPI. 

The desire to resolve these challenges was the reason Just Associates was born. 

We started with little more than a track record of successful MPI cleanups, clear insights into the technical requirements necessary for EMPI systems to deliver desired outcomes and a small team of experienced professionals who shared my passion for innovation and quality. We worked exclusively with Cerner, performing all projects on-site. Tracking was done entirely on paper, with stick figures representing production groups and colored dots representing each different downstream system requiring attention. 

It was rudimentary compared to today’s project management software and remote access capabilities. But even then we could see the potential that existed for leveraging technology to improve internal and external data management processes. That vision eventually led to development of IDMaster®, our proprietary workflow software that reduces the time it takes to review duplicate pairs, document validity decisions, track productivity and add efficiency to the entire MPI management process.

But while those technical advances may have improved the ways we solve our clients’ data integrity problems, the same can’t be said for health IT systems. If anything, the adoption of EHR, CPOE, EMPI and other CIS systems has made maintaining data integrity more complex and critical than ever. More systems are interfaced, sending significantly higher volumes of data to populate patient records and other clinical, administrative and financial systems. An error at any point along the way — an incorrect birth date, missed middle initial or misspelled name — can quickly snowball as the information feeds from one system to the next. 

It’s not just a domino effect. It’s exponential. Inaccurate data captured in one system can feed into as many as 50 others before it is detected — assuming it ever is. 

Data integrity in today’s healthcare environment requires more than just the right system capable of running complex matching algorithms. It also requires the processes and ongoing training and education to eliminate the greatest source of errors: human beings.

As hospitals’ needs regarding data integrity have grown broader and more complex, so has the suite of services from Just Associates. Today we offer everything from traditional MPI cleanups to comprehensive outsourced MPI management. We don’t just clean our clients’ data, we uncover the root causes of data integrity issues and teach our clients how to keep their data clean. We work with nearly every vendor platform, offer data migration services and advise hospitals, health information exchanges, accountable care organizations and other data-dependent entities on data governance to ensure that the information entering and flowing across the organizations is clean, accurate and accessible when and where it’s needed.

Our staff is now more than 70 highly trained professionals strong. Our clients are among the most prestigious institutions in the national medical arena, and we, as a firm, enjoy a stellar reputation in the market. 

A lot has changed over the past decade. What hasn’t — and won’t — is our passion for data integrity, our dedication to providing high-quality, expert services and our drive to uncover the next innovation that will take mastering patient identity to the next level.


Just Associates News 

 

Data Integrity Webinar

Join Just Associates and Executive Insights for an informational webinar, “Data Integrity, The Data Detectives” on Wednesday, July 11 from 1:00 p.m. – 2:00 p.m. EST. Presenter Grant Landsbach, RHIA, will share with attendees what is driving the data integrity explosion and why a digital world requires highly trained professionals to “do the dirty work.” Grant is the data integrity / MPI manager for the Sisters of Charity of Leavenworth (SCLHS) and Exempla Health System, a long-standing Just Associates’ client. To register for the event, Click Here

Welcome to the Family!

Please join us in welcoming Karen Proffitt and Monica Mosis to the Just Associates family! Karen joins us as Vice President of Consulting, coming to Just Associates from Exempla Healthcare, where she was system electronic health record (EHR) director. Monica joins us as a Senior Consultant and was previously health information management (HIM) director of St. Anthony Hospital for Centura Health.

Beth Just Speaks at AHIMA

Just Associates president and CEO Beth Just shared her insight on enterprise master patient index (EMPI) management during a recent American Health Information Management Association (AHIMA) audio seminar called Improving Continuity of Care through Effective EMPI Management. The presentation focused on how to avoid errors in patient identification and improve continuity of care by accurately matching people with EMPI records and by facilitating linkage to related service providers.

Just Associates in the News

Beth Just shares with readers the challenges many hospitals must face in achieving a clean master patient index (MPI) and a number of factors that are driving a growing interest in outsourcing MPI management to ensure data integrity, as well as the benefits that can be realized from outsourcing, in her Becker’s Hospital Review article, “Taming the Master Patient Index Management Tiger.” 

She is also quoted as part of a Healthcare IT News feature, “Hospitals put out ‘Help Wanted’ signs for IT personnel,” in which she discusses the shift of many HIM professionals to the IT side of healthcare to fill the gaps and better manage health data and health information. 

Finally, Just shares her thoughts on hiring health information technology (HIT) professionals from within and what executives can expect when they do so in a recent For the Record feature, “An Inside Job.”


Around the Industry 

 

Survey Indicates ICD-10 Delay May Have Been a Good Call

In February, The Centers for Medicare and Medicaid Services (CMS) announced that the compliance date for the nationwide conversion to ICD-10 would be pushed back from the previously determined Oct. 1, 2013 deadline. A recent survey conducted by the Workgroup for Electronic Data Interchange, indicated that a significant number of healthcare provider organizations, health insurance plans and even vendors of IT systems lagged in their preparations for the complex coding upgrade.

Doctors Have Less Control over Stage 2 Meaningful Use Incentives

Providers looking to demonstrate that they are using electronic health records (EHRs) in a meaningful way under Stage 2 of the EHR incentive program may face added challenges not present in Stage 1. That is because a number of Stage 2 rules hinge not on the physician’s use of the EHR, but rather their patients’ use of the technology. For example, under Stage 2 physicians must provide more than 50 percent of their patients with secure online access to their health records, and at least 10 percent of patients must have viewed, downloaded or transmitted this information. 

Final Rule out for State Insurance Exchanges

The Department of Health and Human Services (HHS) has released a final rule to implement state-level Affordable Insurance Exchanges to provide consumers and small employers a one-stop shop for insurance coverage. The rule, which was published in the Federal Register on March 27, includes standards for establishing and operating an exchange, participating insurance plans, determining eligibility of health plans and an individual to enroll in the exchange, and employer eligibility to participate in certain options for small businesses. 

EMRs May or May Not Increase Ordering Rates of Imaging Tests

A recent study published in Health Affairs suggests that EMR usage is associated with higher ordering rates of imaging tests and increased costs where the government has anticipated cost savings from reductions in duplicative diagnostic testing. However, many critics disagree with this claim, stating that the study did not consider EMRs or clinical decision support and the data used was too dated to provide true results. 

HIPAA Omnibus Rule Nears Publication

The Department of Health and Human Services (HHS) Office for Civil Rights has sent the final HIPAA omnibus rule to the Office of Management and Budget for review. The rule would make changes mandated under the HITECH Act to the HIPAA privacy, security, breach notification and enforcement rules, as well as the Genetic Information Nondiscrimination Act of 2008. Approval from the Office of Management and Budget is one of the final steps before the rule is published in the Federal Register. 

Survey Finds Increase in EHR Adoption, Decrease in Physician Satisfaction

More doctors than ever are implementing electronic health records (EHRs), according to a recent study conducted by The Doctors Company. Of the 5,000 physicians surveyed, nearly 30 percent have already implemented EHRs that meet meaningful use criteria, while 14 percent plan to implement EHRs in the next three years. However, 17 percent of respondents have no plans to adopt EHRs at all, despite the promise of incentive payments and reimbursement penalties to those who don’t adopt them, citing frustration with the future of healthcare and their role in it as the source of their apathy.


Tips & Tricks 

 

A few tips from Just Associates, courtesy of our Epic Identity Optimization Service. Did you know that:

  • Updating the nickname table in Epic Identity to make it more robust and remove inappropriate nicknames lets you identify more real matches and have fewer false positives when performing a patient search?
  • Defining standard routines for patient searches improves the accuracy with which the appropriate patient is located and reduces the likelihood of creating a duplicate?
  • Adhering to standard naming conventions reduces data integrity errors and makes it easier to find the correct record at a later time?
  • Creating exclusion lists that eliminate default or invalid data from the search parameters lets you reduce your staff’s workload by reducing the need to review obvious false-positive matches?
  • Building special work (error) queues to bucket different types of errors resulting from inbound transactions or a direct Epic user will allow for the quick identification and resolution of transactions that may compromise the accuracy of the patient’s medical record?

 

Just Associates’ new Epic Identity Optimization Service optimizes Epic system performance and improves data integrity. The end result is an increase in the number of true duplicates identified by Epic Identity, as well as a dramatic reduction in the number of false positives returned by searches. This eliminates the burden of unnecessary review and reduces the creation of new duplicates.
 


Just Associates’ Repair Helps Sharon Regional Maintain a Pristine MPI

 

Based in Sharon, Penn., Sharon Regional Health System is a comprehensive health system consisting of a 241-bed hospital, 17 satellite centers and more than 1,750 employees. To keep pace with significant growth in medical services and the number of patients served, it is finalizing implementation of a $13 million electronic health record (EHR) system across the enterprise. To prepare for deployment, Sharon Regional brought in Just Associates to conduct a comprehensive master patient index (MPI) cleanup and eliminate existing duplicate records from the system. 

However, once the cleanup was complete, the health system still faced a dilemma: how to maintain that clean MPI. Like many hospitals, limited resources made it particularly challenging for Sharon Regional to achieve the necessary level of efficiency in the MPI management process. Further, the MPI management process was entirely manual. 

“Multiple registration points made it difficult to pinpoint when and where potential errors entered the system, and staffing limitations made it difficult to quickly evaluate and reconcile possible duplicates once they were identified,” said Barb McKee, director of business office operations, Sharon Regional Health System, adding that there was also no good way to identify when additional training or revised procedures were needed. “These are the reasons why, when we heard about Repair, we knew immediately it was the long-term solution we needed.”

Repair: The Outsourced Solution

With its MPI cleared of duplicates, Sharon Regional recognized that it was the ideal time to implement changes to maintain data integrity. Outsourcing was the natural solution. It would ensure ongoing and instant identification of duplicates and, more importantly, free internal resources to focus on longer-term strategies that would improve care quality and safety.

The health system again engaged Just Associates, this time for its Repair service to provide ongoing duplicate resolution. 

Repair leverages remote technologies to link directly into Sharon Regional’s MPI system. When a potential duplicate or integrity issue is identified, a report is automatically transmitted to Repair for review and reconciliation by Just Associates’ specially trained, highly experienced professionals. Possible duplicates are validated and, if confirmed, reconciled directly in Sharon Regional’s system. Though rare, in cases where a potential duplicate cannot be validated, it is returned to Sharon Regional’s staff for resolution. 

Repair also provides Sharon Regional with secure access to real-time information and a variety of reporting tools and analytics, which enables the easy identification of areas where duplicates are created and the types of errors being made. This insight pinpoints where training is needed so programs can be developed to strengthen specific areas. 

Multiple Benefits

Outsourcing has afforded Sharon Regional a new peace of mind that comes from knowing that Repair is continuously working in the background to handle any data integrity issues and negate potential impacts to patient care and safety.

In the first four months, 330 potential duplicates were identified. Of those, just four could not be resolved by Just Associates and Repair. 

The business intelligence available through Repair has also proven to be invaluable. For example, the system at one point identified an unusually large number of registration errors within one week. The analysis determined that all the errors were generated in the same department.

“By providing additional training and education, the number of registration errors originating from the department has dropped to single digits,” said McKee. “Without Repair, I don’t know how long those errors would have been out there or how many would have been created before the problem was identified. Repair nipped that really quickly.”

By keeping the process clean and ensuring anyone with access to the registration system is properly trained, the number of duplicates within the MPI at any point in time continues to decline. 

“There is a quality aspect to data integrity,” said McKee. “Improved safety and quality comes from properly managing the MPI to ensure it remains duplicate free. That is what Repair does for Sharon Regional.”


How Clean MPIs Can Enhance the Patient Portal Experience

 

The following article is an amended version of “A Positive Side-Effect: How Clean MPIs Can Enhance the Patient Portal Experience,” which appeared in Executive Insights on May 21, 2012. 

Patient portals are emerging as an effective channel of communication and information exchange between hospitals, physicians and their patients. They are also a key element of many hospitals’ meaningful use strategies, as several proposed Stage 2 requirements hinge on both physician and patient use of electronic health records (EHRs).

For example, under Stage 2, eligible hospitals and providers must provide more than 50 percent of unique patients discharged from the inpatient or emergency department or seen during the EHR reporting period with secure online access to their health records. At least 10 percent of patients must have viewed, downloaded or transmitted this information. Further, clinical summaries must be provided to patients within 24 hours for more than 50 percent of office visits. 

Patient portals can streamline these processes. However, realizing their full value can be hindered by a problem that is shared by the majority of hospitals across the nation: duplicate patient records. Left unchecked, duplicates can prevent patients from fully utilizing portals. They can also increase the resources necessary to support the portal and its users, which will ultimately impact the return on a facility’s investment and user satisfaction rates.

That is why a proactive strategy for eliminating duplicate records from the master patient index (MPI) is a central element of any patient portal initiative, something to which Vanderbilt University Medical Center can attest given the success of its MyHealthAtVanderbilt portal.

My Health At Vanderbilt

My Health At Vanderbilt is a homegrown patient portal with 187,000 registered users. When it launched in 2004, functionality was limited to secure messaging between clinician and patient. Today, in addition to sending secure messages that are triaged by a nurse and answered within 48 hours, the portal allows patients to make appointments and pay bills.

Patients can also use the portal to access problem, medication and allergy lists; immunization histories; and certain test results, including radiology. Accounts can even be customized to provide alerts for prevention screenings, such as mammograms and colonoscopies. 

Vanderbilt’s patient portal is also being tested as a way to address one of the most perplexing issues confronting healthcare: chronic conditions. A pilot program is underway for patients with chronic hypertension in which participants use their online journal to track daily blood pressure results, which are then evaluated by a nurse practitioner. When there is an increase, the nurse will contact the patient to discuss underlying factors that may have caused the spike, such as a change in diet or missed medications. 

This basic interaction alone has helped 80 percent of participating patients bring their hypertension under control. If daily monitoring and interacting through MyHealthAtVanderbilt continues to deliver positive outcomes, plans call for the program to be expanded to other chronic conditions to help educate patients and get them actively engaged in management of these diseases.

Clearing Duplicate Roadblocks

When it comes to patient portals, all the functionality and successful outcomes in the world are meaningless if patients can’t register or are prohibited from accessing all available features. Unfortunately, that’s what happens when duplicate records exist in the system. That log jam must be cleared before the patient can realize the full portal experience. Considering that the average hospital has a duplicate volume of 3 percent to 10 percent, it is an obstacle that every facility with a patient portal will experience at some point in time. 

Vanderbilt is no exception.

When a patient registers to use MyHealthAtVanderbilt, the system populates the account by linking to the patient’s electronic medical record. If that patient is associated with two records, for example one with a social security number and one without, access will be limited. The patient may be able to message their physician but won’t have access to test results. 

Until the duplicate record is validated and then reconciled or merged, the patient is locked out of the most valuable aspects of the patient portal. This can cause the patient frustration and confusion, tempering any positive experience they may have with the portal. It can also create an embarrassing patient service issue for the hospital, regardless of how quickly the matter is resolved.

Because patient records are integral to the success of Vanderbilt’s portal, the health information management (HIM) department plays a central role in providing the support necessary to keep it functioning smoothly. Two credentialed HIM professionals are dedicated to serving as the portal’s help desk. When a duplicate record issue prevents a patient from registering an account with the portal, the HIM help desk investigates and takes the appropriate corrective action. 

Maintaining a Clean MPI

There is no question that the patient portal experience at Vanderbilt is enhanced through its proactive approach to resolving issues that arise when duplicates impact registration. But it is just a side benefit to the system’s focus on achieving and maintaining a clean MPI for the long term.

Vanderbilt has engaged Just Associates to conduct a comprehensive, two-pronged assessment of its MPI. The first was identification of the most effective algorithms for searching the 3 million records it contains to identify a single patient at the point of registration regardless of where they are in the system. The second will determine where in the process duplicates are most often being created. 

With 1.5 million annual patient encounters in the health system’s clinics alone, avoiding the creation of duplicate records is a daunting task. By improving the algorithms registrars use to search for existing patient records and by shoring up weaknesses in the process through enhanced training, Just Associates will significantly reduce the number of new duplicates. 

The patient portal is an important aspect of Vanderbilt’s ongoing IT strategy. It is evolving constantly as patient demand and technology evolves. By eliminating duplicates from the system, Vanderbilt is ensuring that no patient who wants to enjoy the convenience and benefits that come from using MyHealthAtVanderbilt is kept from doing so, even temporarily.


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