1. Contributions by:Deb Cockroft Cheryl Martin Hunter Merritt Don’t Get Dup’d Understanding the Cause, Effect and Prevention of Duplicate Medical Records Presented by: John Danahey

2. Presentation Approach Presentation 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? Agenda

3. “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

4.  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 percent 6 What Problem?

5. Interesting Study? Record SizeDuplicate % <300,0004.9% 300k – 500k7.4% 500k – 800k6.2% 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

6. Causes What are the causes of duplicate medical records?

7. Causes Mergers Overlap Populations Overlap Populations Human Errors - Staff Typos Typos Misspellings Misspellings Poor training Poor training “Performance Anxiety” “Performance Anxiety”

8. Causes (cont) Human Errors – Patient Poor Historian Poor Historian Use of Nicknames Use of Nicknames Name Changes Name Changes Hospital Processes Decentralized Registration Decentralized Registration Reference Lab Specimens Reference Lab Specimens Physician Office EMR Integration Physician Office EMR Integration

9. Computer System as Cause? Is our MPI Search adequate? MEDITECH uses a combination of: “Exact Match” algorithms – 20-40% accurate with high volume of false matches. 8 “Exact Match” algorithms – 20-40% accurate with high volume of false matches. 8 “Rules-based” algorithms (Soundex) with a 50- 80% accuracy. 9 “Rules-based” algorithms (Soundex) with a 50- 80% accuracy. 9

10. The Problem with Soundex

11. Costs What are the costs associated with duplicate medical records?

12. Clinical Costs Clinical Decisions based on an incomplete record Clinical Decisions based on an incomplete record Repeat Testing increases clinical risk and may be uncomfortable Repeat Testing increases clinical risk and may be uncomfortable Customer Service/Patient Trust is compromised Customer Service/Patient Trust is compromised

13. Direct Costs Corrupt MPI slows down every registration Corrupt MPI slows down every registration Increase Registration Time to enter new patient vs. demo recall Increase Registration Time to enter new patient vs. demo recall Supply costs related to Medical Record folders, Radiology Jackets, etc. Supply costs related to Medical Record folders, Radiology Jackets, etc. Time spent to locate and correct duplicates Time spent to locate and correct duplicates Repeat Testing Due to “Lost” Results and/or Time Spent by Departments “finding” results Repeat Testing Due to “Lost” Results and/or Time Spent by Departments “finding” results Revenue Cycle Inefficiencies common with new registrations vs. demo recall Revenue Cycle Inefficiencies common with new registrations vs. demo recall

14. Legal/Regulatory Costs JCAHO requirements for single, unique identifier – “readily available for patient care” 10 JCAHO requirements for single, unique identifier – “readily available for patient care” 10 HIPAA – Administrative Simplification – Individual Identifier. HIPAA – Administrative Simplification – Individual Identifier. CMS/OIG/Other Payers - 72 Hour Rule - Medical Necessity Frequency Requirements CMS/OIG/Other Payers - 72 Hour Rule - Medical Necessity Frequency Requirements Legal Liability due to Compromised Patient Care Legal Liability due to Compromised Patient Care

15. Actual Dollars “… can be a minimum of $50 per pair.” 11 “… can be a minimum of $50 per pair.” 11 “… at least $25 per record.” 12 “… at least $25 per record.” 12 “… $25 to $400 per duplicate set.” 13 “… $25 to $400 per duplicate set.” 13 Hospital Study: Average time to find, clean and merge was 30 to 45 minutes. 14 Hospital Study: Average time to find, clean and merge was 30 to 45 minutes. 14 Conservative Cost Model: $19.82 15 Conservative Cost Model: $19.82 15 “… $20 to several hundred dollars.” 16 “… $20 to several hundred dollars.” 16

16. The CFO View Conservative Estimates: Average Duplicate Rate: 5% Average Cost per Duplicate: $20 Registrations/DayPossible DuplicatesCost/DayAnnualized Cost 1005$100$36,500 20010$200$73,000 30015$300$109,500 50025$1,000$365,000

17. Some Observations The more duplicates in the system, the higher the rate of new duplicates. Growth rate becomes exponential. 14 The more duplicates in the system, the higher the rate of new duplicates. Growth rate becomes exponential. 14 The longer a duplicate remains in the system, the more difficult/costly it is to fix. The longer a duplicate remains in the system, the more difficult/costly it is to fix. There is a cost for doing nothing. There is a cost for doing nothing.

18. Preventing Duplicates Assess your current MPI Assess your current MPI Develop organizational understanding (Clinical and Financial) Develop organizational understanding (Clinical and Financial) Clean-up existing MPI Clean-up existing MPI Increase User Training in Registration Areas Increase User Training in Registration Areas Enhance MEDITECH to improve MPI Search? Enhance MEDITECH to improve MPI Search? Create Pro-Active Monitoring Procedures Create Pro-Active Monitoring Procedures

19. References 1. Hewitt, Joseph B. and O’Connor, Michele. “Connecting Care through EMPIs,” Journal of AHIMA 73, no. 10 (2002): 33-38. 2. Fox, Leslie Ann and Thierry Sheridan, Patty. “HER Preparation: Building Your MPI Game Plan,” Advance Online Editions, (02 Feb 2004). 3. Just Associates, Inc. “Industry Problem.” Just Associates, Inc. Retrieved on May 23, 2005 from http://www.justassoc.com/industryproblem.asp. http://www.justassoc.com/industryproblem.asp 4. Genry, Lynne and Harnish, Patricia A. “Decimating Duplicates.” Journal of AHIMA 70, no.6 (1999): 65-66. 5. Wheatley, Victoria. “Unique Identifiers: Preparing for HIPAA,” AHIMA Conference Proceedings, 2002. 6. Griffin, Cheryl and Corrado, Judi. “Gaining Search Efficiencies for Identity Management.” AHIMA Convention Proceedings, October 2001. 7. Hewitt and O’Connor. “Connecting Care through EMPIs.” 8. AHIMA MPI Task Force. “Building an Enterprise Master Person Index.” (AHIMA Practice Brief) Journal of AHIMA 75, no. 1 (January 2004): 56A-D. 9. Ibid.

20. References 10. Fernandes, Lorraine and Lenson, Celia and Hewitt, Joe and Weber, jerry and Yamamoto, Jo Ann. “Medical record number errors.” Initiate Systems, Inc. (Apr 2001) Retrieved on January 20, 2005 from http://www.initiatesystems.com/web/resources/exec_summary/38/Me dical_record_numbers_errors.html. http://www.initiatesystems.com/web/resources/exec_summary/38/Me dical_record_numbers_errors.html http://www.initiatesystems.com/web/resources/exec_summary/38/Me dical_record_numbers_errors.html 11. Fox and Therry Sheridan. “EHR Preparation: Building Your MPI Game Plan.” 12. Padfield, Stan. “Managing Merger Mayhem.” Health Management Technology. (Feb 2002) Retrieved on May 23, 2005 from http://www.healthmgttech.com/archives/h0200managing.htm. http://www.healthmgttech.com/archives/h0200managing.htm 13. Wheatley, Victoria. “The Significance of the MPI.” 2001 HIMSS Proceedings: Workshops. 14. Mays, Susan and Swetnich, Donna and Gorken, Lynda. “Toward a Unique Patient Identifier.” Health management Technology. (Mar 2002) Retrieved on April 7, 2005 from http://healthmgttech.com/cgi- bin/arttop.asp?Page=h0302toward.htm. http://healthmgttech.com/cgi- bin/arttop.asp?Page=h0302toward.htmhttp://healthmgttech.com/cgi- bin/arttop.asp?Page=h0302toward.htm 15. Fernandes et al. “Medical record numbers errors” 16. Just Associates, Inc. “Industry Problem” 17. Fernandes et al. “Medical record numbers errors”

21. Thank You John Danahey Vice President Customer Services Division Phone: (978) 805-4153 Email: JohnD@iatric.com JohnD@iatric.com http://www.iatric.com