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Data Integrity Matters™ Newsletter
October 2015

At the start of 2015, it was apparent that there was an intensified focus on Master Patient Index (MPI) data integrity as the Office of the National Coordinator for Health IT (ONC) and the Healthcare Information and Management Systems Society (HIMSS) partnered to develop a strategy to improve consistent patient data matching in health care.

The goal of such a partnership was to develop a tool that contains three main components that are key to improvement: patient matching technology performance measures, data quality measures and a process proficiency measure. 

Engaging a group of stakeholders, primarily from the clinical space, representing hospitals, Health Information Exchanges, Regional Extension Centers and Accountable Care Organizations, the ONC also aims to focus on attestation, which remains a significant problem for hospitals of all shapes and sizes.

Since the announcement of the ONC/HIMSS partnership, the College of Healthcare Information Management Executives (CHIME), the healthcare industry's leading professional organization for CIOs and senior IT executives, has called on innovators worldwide to participate in the CHIME National Patient ID Challenge. This challenge aims to find a universal solution for accurately matching patients with their healthcare information, with a prize of $1 million dollars. 

Here at Just Associates, we were also motivated by a lack of research into the very significant problem of duplicate records and have collaborated with The College of Saint Scholastica to examine the underlying causes. Our objectives are to provide categorized data discrepancies on key patient identifying data fields and analyze the data for additional patterns that may lead to conclusions about what caused the duplicate to be created. The results of the study, which will soon be published in Perspectives, will be available in an upcoming edition of Data Integrity Matters™.

Industry Highlights

Operational Aspects to Consider in Overlay Correction Plan

Maintaining one Master Patient Index (MPI) is already a challenge, but many organizations are merging multiple MPIs as electronic health records (EHRs) are implemented with an eye toward health information exchange. This means that a single error can cascade throughout multiple systems, creating duplicates, overlays and overlaps. 

The registration process is the most common culprit in the creation of overlays. For example, a registrar unwittingly selects the wrong patient and proceeds to overlay the visit/encounter information within that record. Overlaid records can also occur when two patients are merged together in error. 

Correcting existing overlays and preventing the creation of future ones is best accomplished with a comprehensive Overlay Correction Plan to guide the identification and repair process. These plans are complex, with up to 65 different check points, but worth the effort and resources that go into their development. The following considerations will help streamline plan development and ensure key areas are not overlooked. 

Time Considerations

Overlays can take months to repair, especially if the impacted patient has a lengthy inpatient stay. Numerous clinical orders, notes and other documentation must be moved to the correct record or to a new record. Thus, it is imperative to first assess the required time and available resources. 

How much time? While it varies based on number of factors, one large health system calculated that health information management (HIM) staff alone can easily spend eight hours correcting a single basic overlay. More complicated cases involving multiple duplicates can take as much as 30 hours. 

As for resources, industry best practice dictates that HIM Data Integrity staff "own" the overlay correction process and that they be the main facilitators to ensure all steps are taken to resolve the issue. However, HIM alone cannot perform all the required steps. Thus, resource considerations must include collaboration with clinical, pharmacy, providers, billing, and other departments.

Departmental Communications

Several departments are significantly impacted by duplicate and overlaid records and require special consideration within the Overlay Correction Plan. One is the medical records department and the staff responsible for management of release of Information (ROI) requests. 

It is quite possible that a breach (i.e. HIPAA violation) will occur if the co-mingled, overlaid patient documentation is sent to a requesting party that only requested records for one of the patients. The ROI staff may have an authorization to release records for one of the patients but not for both. Thus, the ROI team should be alerted immediately so they can exercise extreme caution when carrying out an ROI request that may involve either of the overlaid records. This process can sometimes be automated, as some EHR systems enable a warning alert to be placed on effected records so that ROI staff and other providers can be alerted to the overlay when accessing certain portions of the record. 

An Overlay Correction Plan should also include the notification of patient billing so a "bill hold" flag can be placed on impacted accounts to help avoid inappropriate billing or release of records to payers. Also, the department responsible for patient portal management should be notified so access can be deactivated for both patients involved in the overlaid record, and reactivated when the issue is resolved.

Review/Reconcile Master Level Data

In addition to departmental notification, the Overlay Correction Plan should guide the HIM Data Integrity staff on reconciling patient data such as Problem List, Past History, Current Medications, and Allergies, etc. Any attending physicians, emergency department physicians, physician assistants, nurses or residents must clarify what medical information belongs to each patient to ensure proper identity.

Once the clinical/EHR patient records have been corrected, there should be additional key steps in the Overlay Correction Plan to cover re-analyzing the chart for issues like deficiencies and coding, etc. These steps will help ensure that overlaid records are prevented in the future. 

Consider Outsourcing

Oftentimes it is beneficial to consider outsourcing an MPI expert to evaluate overlaid records. This helps to save time and free up departments that would otherwise be bogged down with creating and carrying out the Overlay Correction Plan. Just Associates provides consulting to assist clients in developing industry best practice Electronic MPI (EMPI) error correction policies/procedures to improve EMPI data and overall data integrity, which includes the development of Overlay Correction Plans.

Healthcare Industry's Transformation from Volume to Value

The current business model for healthcare delivery in the United States is undergoing a long-term transformation from one that is reliant on reimbursement for the volume of procedures performed to one that rewards cost-control coupled with quality outcomes – the value-based equation. This move creates a set of interrelated requirements designed to achieve what has been labeled the "Triple Aim" approach: improving care, improving population-level health, and reducing costs of healthcare.

Success in managing health across entire populations of people and coordinating care within a variety of inpatient, outpatient and home settings will be vital to realization of value. To address this, the "four pillars" of population health management were created, consisting of data aggregation, risk stratification, care management and patient engagement. 

Each of these pillars will require substantial data analytics. Clean patient data is paramount to deriving the insights needed—which means accurate patient identification is critical.

Imperative to healthcare delivery improvement is the creation of new organizational structures. At state and regional levels, healthcare organizations are coming together to participate in Health Information Organizations (HIOs) that share and transfer patient information within their network through a Health Information Exchange (HIE). Unfortunately, HIEs face two fundamental challenges in creating a reliable and useful database to drive population health and other goals: matching patient records coming in from varied sources and making corrections when errors are discovered with the sender's or HIE's data. 

Adding to the complexity is the lack of standards for required patient demographics and the frequently deficient patient matching algorithms embedded in HIE central systems. As such, organizations will need assistance in identifying and rectifying duplicates and other problematic records that prevent the creation of a comprehensive record for a specific patient.

The HIMSS EHR Association presented the problem this way, "Patient identification that ensures accurate patient record matching across provider sites is a primary concern when aggregating patient information from multiple organizations. Error rates in existing technologies that manage patient identification are sufficiently high to cause concern about medical errors, redundant testing, and inefficiency."

In a December 2014 case study presented to the ONC by research organization NORC at the University of Chicago, the authors noted that HIO stakeholders recognize the need for reliable patient matching and the serious consequences of incorrect matching. Stakeholders reported that "maintaining provider trust in data systems and their value becomes a losing game when they have to contend with data quality issues."

What does this mean for the progress of health IT adoption that is so vital to value-based model? It means healthcare organizations - providers and employers alike - must make the quality of value measurement a central priority. 

To address the two largest challenges in useful database creation, clinicians are encouraged to use EHRs with advanced algorithms to eliminate any potential duplicate patient records that may affect the quality of data being used. This standard will allow for the capture of more reliable clinical and patient data that is so critical to the measurement of value.

This, coupled with the continued partnership between the ONC, federal partners and private sector contributors is helping to further explore and unlock the potential that electronic health information offers to improve decision making, help individuals better manage their health and improve the health system's capacity for rapid learning.

News from Around the Industry


AHIMA, IHE Publish Draft Information Governance, Big Data Paper

Helping healthcare organizations develop a cohesive, standardized approach to information governance in the big data era has been a major focus for the American Health Information Management Association (AHIMA) as providers accumulate databases full of clinical, financial, and claims data.

In a recent Health IT Analytics article, AHIMA is highlighted as a key factor in helping healthcare organizations develop a cohesive, standardized approach to information governance in the big data era. Most recently, AHIMA, in conjunction with Integrating the Healthcare Enterprise (IHE), has helped to develop a white paper exploring the data governance needs of healthcare organizations and providing suggestions for best practices in health information management (HIM). The IHE Information Technology Infrastructure (ITI) White Paper "HIT Standards for HIM Practices" includes use cases and recommendations for managing large volumes of data from EHRs and other health IT sources. 

How Healthcare Big Data Analytics Drives Systematic Improvement

Healthcare organizations have always had an interest in harnessing the potential of big data analytics in pursuit of new treatment strategies and better patient outcomes. That interest has only intensified as EHRs, health information exchanges, and data repositories bring staggering new capabilities to informaticists and data scientists. 

Access to information remains a basic obstacle for many healthcare organizations, even those with certified, brand-name EHRs. To get around the problems involved with extracting, normalizing, and analyzing big data - much of which may be locked up in narrative free-text - providers have turned to a ready source of clinical and financial information: insurance claims. 

A Health IT Analytics article aims to encourage the creation of national data standards and a consensus on how to deploy and use them. The recommendations include the creation of targeted and customized data for delivery improvement that is practical at the physician level, implementation of passive data gathering and reporting – as opposed to EHR alerts which can be cumbersome and distracting – and a richer availability of patient reported data. The article notes that healthcare organizations are walking a fine line between an impersonal, data-oriented system and a customized, person-oriented experience and that the answer for quality outcomes falls somewhere in the middle.

ONC's Deputy National Coordinator: Good Health Data is Essential to Quality Care, Precision Medicine

Dr. Jon White, deputy national coordinator in the Office of the National Coordinator for Health Information Technology (ONC) cites "staggering" EHR adoption numbers, thanks to Meaningful Use Stage 1, in a recent MedCity News article. He also notes the next step in moving health IT forward is the finalization of interoperability standards, which will be ongoing.

White is hopeful that the continued healthy engagement between ONC and congressional staff will provide the collaboration needed to continue working towards national interoperability that will move precision medicine and other various issues forward.

Just Associates News - Achievement Awards and More


Beth Just Receives CHIMA Lifetime Achievement Award

Just, CEO and President of Just Associates, was recognized by the Colorado Health Information Management Association (CHIMA) as a leader among the health information management (HIM) industry who embodies the leadership qualities and continual willingness to participate in the advancement of HIM practices. The Professional Lifetime Achievement Award recognizes individuals who have been in the field for at least ten years and have demonstrated an uncompromising commitment to HIM and a willingness to develop new and improved practices, even in nontraditional settings. 

Linda Bock Receives CHIMA Legacy Award

The Legacy Award, which was created in 2014, recognizes individuals who have recently retired or passed away and held a membership with CHIMA for at least 10 years and remained active in both CHIMA and AHIMA. The Legacy Award winner exemplifies the professional image of the association through participation, leadership, research/development, mentoring, publications and advancement of the profession. Linda passed away earlier this year and Beth Just was able to present the award to her lifelong partner, Skip Davis, in her memory. 

Just Associates in the Industry

Experts from Just Associates are lending deep domain expertise to the future of HIM through active participation on several key state and national association boards and task forces. These include the contributions of Beth Just to the establishment of the healthcare industry's information governance framework as part of the AHIMA Information Governance Principals for Healthcare™ (IGPHC) Task Force. Just also is currently participating on the Information Governance Tools and Resources Workgroup.

Joining Just in high-profile roles with AHIMA is the firm's chief privacy officer, Susan Lucci, RHIA, CHPS, CHDS, who serves on the AHIMA Enterprise Information Management Practice Council. The group advises AHIMA on emerging issues related to Enterprise Information Management and Information Governance with the aim of having the organization become the trusted authority and recognized as the "gold standard" for principles, models and best practices related to Information Governance in healthcare. 

The firm's associatee identity manager, Megan Munns, RHIA, currently serves on the AHIMA Health Information Exchange (HIE) Practice Counsel, which advises the organization on regional, national and state HIE and EHR-based exchange initiatives and best practices in the areas of health record interoperability, data integrity oversight, data and information sharing and exchange and patient identification. This counsel enables the identification and evaluation of advancing technology's effect on the exchange of secure and accurate health information, working towards the goal of real-time interoperability. Munns also serves as Secretary of CHIMA. 

Both Lucci and Munns are also active on the Health Information Technology (HIT) Standards for HIM Practice sub-committee, which define HIM practices that can be supported by HIT products, specify HIM Practice Use Cases for standards-based HIT products and develop a roadmap for filling existing standards and practice needs gaps by prioritizing Use Cases.

Recent Contracts



Just Associates was recently contracted by ProMedica to implement their IDManage® service to provide ongoing MPI Management services. ProMedica, which engaged Just Associates earlier this year to resolve duplicate records prior to its move to Epic, is a large non-profit healthcare system with locations in northwest Ohio and southeast Michigan. It includes 11 hospitals, about 250 physician practices and an insurance company (Paramount).

Stony Brook

Stony Brook University Hospital (SBUH) has also engaged Just Associates' IDManage® service for ongoing MPI management. SBUH is Long Island's premier academic medical center. With 603 beds, it serves as the region's only tertiary care center and Level 1 Trauma Center.

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