Taming the Master Patient Index Management Tiger

Sharon Regional Health System faced a dilemma after completing a comprehensive master patient index cleanup in preparation for its new electronic health record system. While the cleanup had eliminated existing duplicate records from the system, limited internal resources and manual processes meant that maintaining a clean MPI would be an ongoing challenge — one shared by many facilities.

So Sharon Regional made a decision that would put it at the leading edge of an emerging business trend: It outsourced its ongoing MPI management. This enables continuous eradication of duplicate and overlaid records before they expand into problems that could impact safety and quality or increase costs.

An emerging business model
A number of factors are driving the growing interest in outsourcing MPI management, in particular the role it can play in a hospital's data integrity strategy. A well-managed MPI ensures that patient information is clean and accurate, thus mitigating the risk of treatment delays or inappropriate care decisions made based on inaccurate or incomplete information. It reduces costs associated with reconciling duplicate records and longer registration times as well as those incurred when repeat diagnostic tests are necessary because the appropriate record cannot be located. In fact, repetitive testing alone can add up to 30 percent to the typical hospital's clinical costs.

Also at play is the impact a clean MPI can have on a hospital's ability to efficiently achieve meaningful use. That is because several Stage 1 qualifying criteria are tied to a percentage of "unique patients" within a hospital's systems. When that percentage is based on records, which is the recommended approach, even a relatively low duplicate volume will falsely inflate the number of patients to which the criteria must be applied.

For example, one criterion is that 80 percent of patients must have a problem list within the EHR in a structured data format. If a hospital has 1 million unique patient records in its system, 10 percent of which are duplicates, compliance would require problem lists for 800,000 patients. Eliminating those duplicates drops that number to a more easily attained 720,000 patients. If that same hospital had a duplicate volume of 15 percent, eliminating that would drop the number of problem lists required to just 680,000.

Evolving care models are also influencing the growth of outsourced MPI management. Emerging initiatives like accountable care organizations and patient centered medical homes, along with more established initiatives like health information exchanges and regional health information organizations, all rely on the accurate exchange of valid patient data for short- and long-term sustainability.

Multiple challenges
Despite the significant role it plays in multiple strategies, numerous obstacles stand in the way of a clean MPI. Limited resources make it particularly challenging for many hospitals to achieve the necessary level of efficiency in the MPI management process to eliminate existing issues and reduce the likelihood that future ones will develop.

The typical MPI management process is primarily manual and therefore inefficient and prone to human error. In fact, many hospitals use rudimentary reports as their primary tool for identifying duplicates and spreadsheets for tracking them. The process itself is also time-consuming and labor-intensive, requiring dedicated human resources and special expertise that few hospitals can retain.

Limited resources also prevent many hospitals from employing a more efficient technology-enabled assembly line approach to validating and reconciling duplicates — one that leverages not only individual strengths but also technologies that drive more rapid reconciliation by enabling the simultaneous viewing of hundreds of pairs of potential duplicates.

Additional challenges include declining reimbursements and tightening budgets that make it increasingly difficult for hospitals to dedicate sufficient staff levels to fully and effectively manage the MPI. Many struggle to maintain productivity levels due to staff turnover, planned and unplanned leave time and insufficient training.

Added to the mix are the increase in consolidations and the number of physician practices being acquired by hospitals, all of which necessitate integration of divergent MPIs. Finally, implementation of new EMR and computerized provider order entry systems exacerbates the challenges of maintaining data integrity, particularly when problems must be corrected manually.

Sharon Regional's approach
These were all challenges with which Sharon Regional struggled. Based in Sharon, Penn., Sharon Regional is a comprehensive health system consisting of a 248-bed hospital, 21 satellite centers and more than 1,750 employees. The health system brought in Just Associates to conduct a comprehensive MPI cleanup in preparation for its May 2012 EHR system implementation. But without any change in the status quo, maintaining a clean MPI would be nearly impossible.

In Sharon Regional's case, staffing limitations made it difficult to quickly evaluate and reconcile possible duplicates once they were identified. Also problematic were the multiple registrations points, which made it difficult to pinpoint when and where potential errors were entering the system. As a result, there was not and effective way to identify when additional training was needed or where policies and procedures might need revisiting. This was especially true of those departments that input registrations infrequently and therefore may not understand the importance of reviewing the MPI before creating a new patient record.

Finally, like many facilities, the MPI management process at the health system was entirely manual. This made it difficult to focus on long-term MPI integrity, as the few resources available for ongoing maintenance were focused on identification, validation and reconciliation of duplicates.

With its MPI cleared of duplicates, Sharon Regional recognized that it was the ideal time to implement changes to ensure that it stayed that way. Outsourcing was the natural solution. It ensured that duplicates and overlays would be identified and quickly eliminated. More importantly, it freed internal resources to focus on longer-term strategies that would improve care quality and safety.

The service ultimately engaged by the health system to manage ongoing duplicate resolution leverages remote technologies to link directly into Sharon Regional’s MPI system. When a potential duplicate or other data integrity issue is identified, the service is automatically alerted, duplicates are validated and, if confirmed, reconciled directly in the system. If a determination cannot be reached, it is returned to Sharon Regional for resolution.

This automated process is key because it eliminates internal workflow disruptions and allows management activities to take place transparently in the background. In fact, in the first four months, 330 potential duplicates were identified. Of those, just four could not be resolved by the outsourced provider.

Remote technologies and direct links to the MPI system also enable application of actionable business intelligence tools. This allows Sharon Regional to target areas for additional registration staff training to reduce new data integrity issues from being introduced into the system.

Multiple benefits
Sharon Regional's experiences with outsourced MPI management are far from an anomaly. As more evidence emerges of its ability to address the serious issues impacting data integrity and process efficiencies, more hospitals and healthcare organizations are seeking outside assistance in managing their MPIs.

Outsourcing key health information management services is not without precedent. Healthcare organizations have for years been outsourcing such functions as release of information, transcription and coding without affecting their core competencies. Outsourcing MPI management delivers similar results, including increased productivity, efficiency and accuracy. It also positions hospitals to maximize the impact of their IT initiatives, such as deployment of EHRs, at multiple clinical and operational levels.

Outsourced service providers leverage such advances as cloud technology, software as a service and improved interfaces, as well as advanced duplicate workflow software. This enables them to cost-effectively resolve issues, seven days a week, to ensure the MPI stays clean.

In fact, ongoing resolution is the real value of outsourced MPI management. It can be done as frequently as a hospital needs and allows any new issues to be identified and eradicated before they affect data integrity. It also frees internal HIM staff to handle higher priority areas of patient safety and data management .

Given the depth of MPI management's financial and clinical impacts, it makes sense that outsourcing it is gaining acceptance as a smart strategy for achieving the highest level of data integrity.

Beth Haenke Just (bjust@justassociates.com) is CEO and president of Just Associates (www.justassociates.com), a data integrity consulting firm specializing in patient identity solutions for the HIM, health informatics and health IT markets.

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