1. Health Management Information Systems
Welcome to Health Management Information Systems, Administrative, Billing, and Financial Systems. This is Lecture b.
This lecture defines a master patient index or MPI and describes its core elements and discusses current trends to establish a unique patient identifier.
Administrative, Billing, and Financial Systems
Lecture b
This material (Comp 6 Unit 9) was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated by Normandale Community College, funded under Award Number 90WT0003.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit

2. Administrative, Billing, and Financial Systems Learning Objectives
Discuss the core elements of a Master Patient Index (MPI)
Describe current trends to establish a Unique Patient Identifier (UPI)
The Objectives for this lecture, Administrative, Billing, and Financial Systems lecture b are to:
Discuss the core elements of a Master Patient Index (MPI) and,
Describe current trends to establish a Unique Patient Identifier (UPI).

3. Patient Management and Billing
Systems that support the management of the patient
Example
Patient identification
Supporting technology
Master patient index
As was explained in lecture a, patient management and billing systems are systems that support the management of the patient.
An example would be the patient identification functionality and the supporting technology and master patient index. The master patient index contains information about the patients.

4. Master Patient Index (MPI)
Centerpiece for all subsequent functionality and software applications
Links to the patient health record
Links to scheduling for appointments, reporting lab, x-ray, pharmacy, patient-related images
What is the master patient index and why is it so essential? The Health Care Information Management and Systems Society (HIMSS, 2010) explains why the master patient index is essential: “The MPI is important because it serves as the centerpiece for all subsequent functionality and software applications, such as links to the patient clinical record, the patient schedule for appointments, reporting lab, x-ray, pharmacy, patient-related images, etc.” (p. 77).

5. Master Patient Index (MPI)
AHIMA definition
“A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death”
AHIMA (2012) defines a master patient index as “A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death” (p. 210).

6. Purpose of the MPI
Provides the index, location of, and access to a patient’s EHR in an enterprise
Facilitates intraoperability and the accurate creation of a longitudinal record
Ensures accurate and complete linking of EHRs for HIE
AHIMA (2010a, September) notes that one of a health care organization’s most important resources is the MPI as it provides the link to access patient health information across all care settings. The AHIIMA (2010a, September) Practice Brief lists the following reasons why:
“Provides the index, location of, and access to a patient’s EHR in an enterprise,
Facilitates intraoperability and the accurate creation of a longitudinal record for a patient by linking records across multiple clinical systems, facilities, and provider EHRs and,
Ensures accurate and complete linking of EHRs for health information exchange across participating organizations, including health care organizations, reference labs, registries, pharmacies, and public health databases” (para. 3).

7. Purpose of the MPI Establishes a streamlined governance process
Accurately matches persons being registered for care with their existing medical records
Additional reasons the MPI is one of a health care organization’s most important resources, stated by AHIMA (2010a, September) include:
“Establishes a streamlined governance process supported by data management strategies that will ensure the accuracy of data models, stewardship, policies, and procedures and,
Accurately matches persons being registered for care with their existing medical records, thus minimizing duplicate records within a facility and across patient care settings” (para. 3).

8. Core Elements of an MPI Internal patient identification Person name
Date of birth
Gender
Race
Ethnicity
AHIMA (2010b, September) defined the core elements as follows:
Internal patient identification - Primary identifier used by the facility to identify the patient at admission (e.g., the medical record number).
Person name - Legal name of patient or person, including surname, given name, middle name or initial, suffixes (e.g., junior, IV), and prefixes (e.g., Father, Doctor).
Date of birth - Year, month, and day of birth (e.g., YYYY/MM/DD).
Gender - For example, male, female, unknown, or undetermined.
Race - Race is a concept used to differentiate population groups largely on the basis of physical characteristics transmitted by descent. Races currently used by the federal government for statistical purposes are American Indian or Alaskan Native, Asian or Pacific Islander, Black, White, Unknown, Other, and Missing.
Ethnicity - Ethnicity is a concept used to differentiate population groups on the basis of shared cultural characteristics or geographic origins. Ethnic designations currently used by the federal government for statistical purposes are Hispanic origin, not of Hispanic origin, and Unknown, Other, and Missing.

9. Core Elements of a MPI Address Telephone number
Alias/previous/maiden names
Social security number
Facility identification
Universal patient identifier (UPI)
Account/visit number
More core elements of an MPI according to AHIMA (2010b, September) are:
Address - Address or location of patient's residence. Components include the street address, other designation (e.g., apartment number), city, state/province, zip or postal code, country, and type of address (e.g., permanent, mailing).
Telephone number - Telephone number at which that patient can be contacted. This may be a home or business telephone number or the telephone number of a friend, neighbor, or relative.
Alias/previous/maiden names - Any names by which the patient has been known other than the current legal name, including nicknames, maiden name, previous name that was legally changed, etc. All previous names available should be converted and retained.
Social security number - Personal identification number assigned by the US Social Security Administration.
Facility identification - The unique identification number of a facility where patients seek care. (The Centers for Medicare and Medicaid Services (CMS)has developed a provider ID system for healthcare facilities).
Universal patient identifier - Not yet implemented by HIPAA regulation, but this field is often used as an internal ID that links multiple systems.
Account/visit number - Number assigned by the facility billing or accounting office for all charges and payments for this encounter or visit.

10. Core Elements of an MPI Admission/encounter/visit date
Discharge or departure date
Encounter/service type
Encounter/service location
Encounter primary physician
Patient disposition
The final core elements of an MPI per AHIMA (2010b, September) are:
Admission/encounter/visit date – Date that the patient actually arrived for care (e.g., YYYY/MM/DD/HH/SS)
Discharge or departure date - Date the patient actually left the facility or died (e.g., YYYY/MM/DD/HH/SS)
Encounter/service type - Categorization of the encounter, such as emergency, inpatient, outpatient, home care, or electronic (e.g., , Internet, telemedicine)
Encounter/service location - Location in which the encounter, visit, or treatment occurred
Encounter primary physician - Attending physician for the associated encounter, visit, or treatment, identified with the primary physician's National Provider Identifier
Patient disposition - Patient's intended care setting after discharge. Examples include discharge to home (not to home health service), acute care hospital, nursing facility, home to be under the care of a home health service, or other health care facility; left against medical advice (AMA); alive, other, or not stated; died; admitted to hospital; admitted for observation; transferred to skilled nursing facility, intermediate care facility, or other facility; or other disposition as dictated by type of MPI.

11. Unique Patient Identifier (UPI)
Value permanently assigned to an individual for identification purposes
Unique across the entire national health care system
Not shared with any other individual
While listed as one of the core elements of an MPI, it is noted that a UPI has not yet been established. The AHIMA (2012) definition of this core element is “A personal identifier applied to a patient, such as a number or code, that is used permanently for many and varied purposes” (p. 350).
The Core Health Data Elements, published by the National Committee on Vital Health Statistics (NCVHS), also includes the use of a UPI. In addition, the 1996 Health Insurance Portability and Accountability Act (HIPAA) mandated UPI systems, but security concerns have stalled those efforts. Consequently, the UPI as already noted has not yet come to fruition, although the field is often used as an internal UPI.
NCVHS (1997) broke the term “Unique Patient Identifier” down into individual components and then summarized the results in a definition that states “the identity of an individual consists of a set of personal characters by which that individual can be recognized. Identification is the proof of one's identity. Identifier verifies the sameness of one's identity. Patient Identifier is the value assigned to an individual to facilitate positive identification of that individual for healthcare purposes. Unique Patient Identifier is the value permanently assigned to an individual for identification purposes and is unique across the entire national healthcare system. Unique Patient Identifier is not shared with any other individual” (para. 7).
Possible benefits of a UPI include the potential to assure prompt access to health care information, timely delivery of care, linkage of lifelong health records of individuals, and aggregation of health information for analysis and research (NCVHS, 1997).

12. Functions a UPI Must Support
Identification of an individual
Identification of information
Accurate identification functions
Reduce health care operational cost and enhance the health status of the nation
The four basic functions that a UPI must support according to NCVHS (1997) are:
“Identification of an Individual:
for the purposes of delivery of care (diagnosis, treatment, blood transfusion, medication, etc.), and
for administrative functions (e.g. eligibility, reimbursement, billing, payment, etc.).
Identification of Information:
Identification and access to patient information for prompt delivery of care during current encounter, coordination of multi-disciplinary patient care services and communication of orders, results, supplies, etc.,
Organization of patient care information into a manual medical record chart or an automated electronic medical record for both current and future use,
Manual and automated linkage of various clinical records pertaining to a patient from different practitioners, sites of care and times to form a lifelong view of the patient's record and facilitate the continuity of care in future, and
Aggregation of information across institutional boundaries for population-based research and planning.
Accurate identification functions (to provide timely access to patient care information) and de-identification functions (to support the protection of security, privacy and confidentiality of patient information).
Reduce health care operational cost and enhance the health status of the nation by supporting both automated and manual patient record management, access to care and information sharing” (para. 8).

13. Current Trends to Establish a UPI
HIPAA
Requires unique identification numbers
UPI has not been adopted
ONC’s Health Information Technology Standards Committee (HITSC)
Patient Matching Power Team
Recommendations
Most agree that unique identification numbers are needed for patients, but there is no consensus on the method of identification. HIPAA regulations require unique identification numbers that can be used across information systems although an individual patient identifier (UPI) has not been adopted due to a number of factors, specifically privacy and security concerns.
As a result of a Health Information Technology Policy Committee (HITPC) request to the Health Information Technology Standards Committee (HITSC), several "power teams" were formed to come up with recommended standards. One team, the Patient Matching Power Team, was responsible for providing best practice guidance for use of demographics in machine to machine matching of patient identifiers. This team made four recommendations related to patient attributes that could be used for matching, quality of the data, formats for these data elements, and what data are returned from a match request (HITSC 2011).
Potential patient matching attributes were examined by the Patient Matching Power Team and they concluded “Having a common “base” set of patient attributes across entities that are matching patients is important if the entities are going to achieve an acceptable level of sensitivity and specificity” (HITSC, 2011, p. 2).

14. Administrative, Billing, and Financial Systems Summary
Applications that need to be integrated in health care information systems;
Strategies used by health care organizations to ensure integration of functions;
Critical elements needed to integrate billing, financial, and clinical systems;
Core elements of a Master Patient Index (MPI)
This concludes lecture b of Administrative, Billing, and Financial Systems. This lecture defined a master patient index or MPI and described its core elements and discussed current trends to establish a unique patient identifier.

15. Administrative, Billing, and Financial Systems References – Lecture b
AHIMA. (2010a, September). Fundamentals for building a Master Patient Index/Enterprise Master Patient Index (Updated) Journal of AHIMA, 81(4), Retrieved from
AHIMA. (2010b, September). Fundamentals for Building a Master Patient Index/Enterprise Master Patient Index (Updated): Appendix A Recommended core data elements for EMPIs. Journal of AHIMA, 81(4), Retrieved from
American Health Information Management Association. (2012). Pocket glossary for health information management and technology (3rd ed.). Chicago, IL: Author.
Healthcare Information and Management Systems Society (HIMSS). (2010). HIMSS dictionary of healthcare information technology terms, acronyms and organizations (2rd ed.). Chicago, IL: Author.
Health Information Technology Standards Committee (HITSC) Patient matching power team recommendations.
National Committee on Vital and Health Statistics. (1997). Part three: Unique patient identifier. Retrieved from
No audio.

16. Administrative, Billing, and Financial Systems Lecture b
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated by Normandale Community College, funded under Award Number 90WT0003.
No audio
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