Contributions by:Contributions by: Deb CockroftDeb CockroftCheryl MartinCheryl MartinHunter MerrittHunter Merritt

Don’t Get Dup’dDon’t Get Dup’dUnderstanding the Cause, Effect and Understanding the Cause, Effect and

Prevention of Duplicate Medical RecordsPrevention of Duplicate Medical Records

Presented by: Presented by: John DanaheyJohn Danahey

Presentation ApproachPresentation Approach

How big of a problem is it?How big of a problem is it?

What are the causes?What are the causes?

What are the costs?What are the costs?

How do we prevent future duplicates?How do we prevent future duplicates?

AgendaAgenda

“Behind every medical record is a patient whose care depends on a thorough understanding of

current and past medical conditions. When that understanding is compromised due to an

incomplete record, care suffers.”1

Average duplication rate is 5% -10% … up to 25% for IHDNs.2

“… somewhere between 3% to as high as 15+%”3

150,000 (out of 787,000) possible duplicates at WA based healthcare system.4

“… at least 5 percent of the records”5

… sometimes approaching 10 to 15 percent6

What Problem?What Problem?

Interesting Study?Interesting Study?

Record Size Duplicate %

<300,000 4.9%

300k – 500k 7.4%

500k – 800k 6.2%

800k + 9.8%

Conclusions:

• 5% - 10% Average Facility Duplication Rate

• The larger the facility, the higher the potential for duplicates

• IHDN’s have greater potential for duplicates

Based on the study of 70 facility level MPI files.7

CausesCauses

What are the causes of What are the causes of

duplicate medical records?duplicate medical records?

CausesCauses

MergersMergers Overlap PopulationsOverlap Populations

Human Errors - StaffHuman Errors - Staff TyposTypos MisspellingsMisspellings Poor trainingPoor training ““Performance Anxiety”Performance Anxiety”

Causes (cont)Causes (cont)

Human Errors – PatientHuman Errors – Patient Poor HistorianPoor Historian Use of NicknamesUse of Nicknames Name ChangesName Changes

Hospital ProcessesHospital Processes Decentralized RegistrationDecentralized Registration Reference Lab SpecimensReference Lab Specimens Physician Office EMR IntegrationPhysician Office EMR Integration

Computer SystemComputer Systemas Cause?as Cause?

Is our MPI Search adequate?Is our MPI Search adequate?

MEDITECH uses a combination of:MEDITECH uses a combination of: ““Exact Match” algorithms – 20-40% accurate Exact Match” algorithms – 20-40% accurate

with high volume of false matches.with high volume of false matches.88

““Rules-based” algorithms (Soundex) with a 50-Rules-based” algorithms (Soundex) with a 50-80% accuracy.80% accuracy.99

The Problem with The Problem with SoundexSoundex

CostsCosts

What are the costs associated with What are the costs associated with

duplicate medical records?duplicate medical records?

Clinical CostsClinical Costs

Clinical Decisions based on an incomplete Clinical Decisions based on an incomplete recordrecord

Repeat Testing increases clinical risk and may Repeat Testing increases clinical risk and may be uncomfortablebe uncomfortable

Customer Service/Patient Trust is compromisedCustomer Service/Patient Trust is compromised

Direct CostsDirect Costs

Corrupt MPI slows down every registrationCorrupt MPI slows down every registration Increase Registration Time to enter new Increase Registration Time to enter new

patient vs. demo recallpatient vs. demo recall Supply costs related to Medical Record folders, Supply costs related to Medical Record folders,

Radiology Jackets, etc.Radiology Jackets, etc. Time spent to locate and correct duplicatesTime spent to locate and correct duplicates Repeat Testing Due to “Lost” Results and/or Repeat Testing Due to “Lost” Results and/or

Time Spent by Departments “finding” resultsTime Spent by Departments “finding” results Revenue Cycle Inefficiencies common with new Revenue Cycle Inefficiencies common with new

registrations vs. demo recallregistrations vs. demo recall

Legal/Regulatory Legal/Regulatory CostsCosts

JCAHO requirements for single, unique JCAHO requirements for single, unique identifier – “readily available for patient care”identifier – “readily available for patient care”1010

HIPAA – Administrative Simplification – HIPAA – Administrative Simplification – Individual Identifier.Individual Identifier.

CMS/OIG/Other PayersCMS/OIG/Other Payers- 72 Hour Rule- 72 Hour Rule- Medical Necessity Frequency Requirements- Medical Necessity Frequency Requirements

Legal Liability due to Compromised Patient Legal Liability due to Compromised Patient CareCare

Actual DollarsActual Dollars

“… “… can be a minimum of $50 per pair.”can be a minimum of $50 per pair.”1111

“… “… at least $25 per record.”at least $25 per record.”1212

“… “… $25 to $400 per duplicate set.”$25 to $400 per duplicate set.”1313

Hospital Study: Average time to find, clean Hospital Study: Average time to find, clean and merge was 30 to 45 minutes.and merge was 30 to 45 minutes.1414

Conservative Cost Model: $19.82Conservative Cost Model: $19.821515

“… “… $20 to several hundred dollars.”$20 to several hundred dollars.”1616

The CFO ViewThe CFO View

Conservative EstimatesConservative Estimates::

Average Duplicate Rate: 5%Average Duplicate Rate: 5%

Average Cost per Duplicate: $20Average Cost per Duplicate: $20

Registrations/Day Possible Duplicates Cost/Day Annualized Cost

100 5 $100 $36,500

200 10 $200 $73,000

300 15 $300 $109,500

500 25 $1,000 $365,000

Some ObservationsSome Observations

The more duplicates in the system, the higher The more duplicates in the system, the higher the rate of new duplicates. Growth rate the rate of new duplicates. Growth rate becomes exponential.becomes exponential.1414

The longer a duplicate remains in the system, The longer a duplicate remains in the system, the more difficult/costly it is to fix.the more difficult/costly it is to fix.

There is a cost for doing nothing.There is a cost for doing nothing.

Preventing Preventing DuplicatesDuplicates

Assess your current MPIAssess your current MPI Develop organizational understanding Develop organizational understanding

(Clinical and Financial)(Clinical and Financial) Clean-up existing MPIClean-up existing MPI Increase User Training in Registration AreasIncrease User Training in Registration Areas Enhance MEDITECH to improve MPI Search?Enhance MEDITECH to improve MPI Search? Create Pro-Active Monitoring ProceduresCreate Pro-Active Monitoring Procedures

ReferencesReferences1. Hewitt, Joseph B. and O’Connor, Michele. “Connecting Care through 1. Hewitt, Joseph B. and O’Connor, Michele. “Connecting Care through

EMPIs,” EMPIs,” Journal of AHIMAJournal of AHIMA 73, no. 10 (2002): 33-38. 73, no. 10 (2002): 33-38.

2. Fox, Leslie Ann and Thierry Sheridan, Patty. “HER Preparation: Building 2. Fox, Leslie Ann and Thierry Sheridan, Patty. “HER Preparation: Building Your MPI Game Plan,” Advance Online Editions, (02 Feb 2004).Your MPI Game Plan,” Advance Online Editions, (02 Feb 2004).

3. Just Associates, Inc. “Industry Problem.” 3. Just Associates, Inc. “Industry Problem.” Just Associates, IncJust Associates, Inc. Retrieved . Retrieved on May 23, 2005 from on May 23, 2005 from http://www.justassoc.com/industryproblem.asp..

4. Genry, Lynne and Harnish, Patricia A. “Decimating Duplicates.” 4. Genry, Lynne and Harnish, Patricia A. “Decimating Duplicates.” Journal of Journal of AHIMAAHIMA 70, no.6 (1999): 65-66. 70, no.6 (1999): 65-66.

5. Wheatley, Victoria. “Unique Identifiers: Preparing for HIPAA,” 5. Wheatley, Victoria. “Unique Identifiers: Preparing for HIPAA,” AHIMA AHIMA Conference ProceedingsConference Proceedings, 2002., 2002.

6. Griffin, Cheryl and Corrado, Judi. “Gaining Search Efficiencies for Identity 6. Griffin, Cheryl and Corrado, Judi. “Gaining Search Efficiencies for Identity Management.” Management.” AHIMA Convention ProceedingsAHIMA Convention Proceedings, October 2001., October 2001.

7. Hewitt and O’Connor. “Connecting Care through EMPIs.”7. Hewitt and O’Connor. “Connecting Care through EMPIs.”

8. AHIMA MPI Task Force. “Building an Enterprise Master Person Index.” 8. AHIMA MPI Task Force. “Building an Enterprise Master Person Index.” (AHIMA Practice Brief) (AHIMA Practice Brief) Journal of AHIMAJournal of AHIMA 75, no. 1 (January 2004): 56A- 75, no. 1 (January 2004): 56A-D.D.

9. Ibid.9. Ibid.

ReferencesReferences10. Fernandes, Lorraine and Lenson, Celia and Hewitt, Joe and Weber, jerry 10. Fernandes, Lorraine and Lenson, Celia and Hewitt, Joe and Weber, jerry

and Yamamoto, Jo Ann. “Medical record number errors.” and Yamamoto, Jo Ann. “Medical record number errors.” Initiate Initiate Systems, Inc.Systems, Inc. (Apr 2001) Retrieved on January 20, 2005 from (Apr 2001) Retrieved on January 20, 2005 from http://www.initiatesystems.com/web/resources/exec_summary/38/Medical_record_numbers_errors.html..

11. Fox and Therry Sheridan. “EHR Preparation: Building Your MPI Game 11. Fox and Therry Sheridan. “EHR Preparation: Building Your MPI Game Plan.”Plan.”

12. Padfield, Stan. “Managing Merger Mayhem.” 12. Padfield, Stan. “Managing Merger Mayhem.” Health Management Health Management TechnologyTechnology. (Feb 2002) Retrieved on May 23, 2005 from . (Feb 2002) Retrieved on May 23, 2005 from http://www.healthmgttech.com/archives/h0200managing.htm..

13. Wheatley, Victoria. “The Significance of the MPI.” 2001 HIMSS 13. Wheatley, Victoria. “The Significance of the MPI.” 2001 HIMSS Proceedings: Workshops.Proceedings: Workshops.

14. Mays, Susan and Swetnich, Donna and Gorken, Lynda. “Toward a 14. Mays, Susan and Swetnich, Donna and Gorken, Lynda. “Toward a Unique Patient Identifier.” Unique Patient Identifier.” Health management TechnologyHealth management Technology. (Mar 2002) . (Mar 2002) Retrieved on April 7, 2005 from Retrieved on April 7, 2005 from http://healthmgttech.com/cgi-bin/arttop.asp?Page=h0302toward.htm..

15. Fernandes et al. “Medical record numbers errors”15. Fernandes et al. “Medical record numbers errors”

16. Just Associates, Inc. “Industry Problem”16. Just Associates, Inc. “Industry Problem”

17. Fernandes et al. “Medical record numbers errors”17. Fernandes et al. “Medical record numbers errors”

Thank YouThank You

John DanaheyJohn Danahey

Vice PresidentVice President

Customer Services DivisionCustomer Services Division

Phone: (978) 805-4153Phone: (978) 805-4153

Email: Email: JohnD@iatric.com

http://www.iatric.comhttp://www.iatric.com