The Risk-Benefit Ratio of Operating Without an EMPI
By: Kelley O. Smith, RN, MPH
Physicians and nurses intuitively understand risk-benefit ratio—the idea of weighing the potential risk associated with a medication, diagnostic test, or treatment protocol against the potential benefit it can offer.
From a business perspective, it’s important that hospitals apply the same careful, strategic thinking to the value of having an enterprise master patient index (EMPI) solution—the ability to have a complete, 360-degree view—or “golden record”—of each patient in the system, without all the risks and complications associated with duplicate patient records. Following are just a few of the risks hospitals agree to take on if they don’t have an EMPI:
- Duplicate tests – Without an EMPI to help eliminate duplicate records, patients can very easily end up being sent for tests they’ve already had. Consider a patient who first visits the ER and then later sees an orthopedic specialist, both for knee pain. Without an EMPI in place, the specialist might not know that the patient had diagnostic scans in the ER only two weeks prior, and may order costly duplicate testing. Or, a patient has multiple chronic conditions and each specialist he visits orders similar sets of lab and radiology tests, which are unnecessary and inconvenient for the patient and costly to the payers.
- Medication errors— Medicine is dispensed to nearly every patient receiving medical treatment, and many individuals are on multiple drugs. This situation is complex and can be dangerous if not managed properly. Without access to a single record, providers are in the dark about the medications their patients are taking. This leads to duplicate meds being prescribed, as well as potential adverse effects resulting from dangerous drug-to-drug interactions or drug allergies that may have been documented in one system but missing from others.
- Wasted marketing resources—Consider a situation in which four minor children live in a household with two parents. Without an EMPI, a physician’s office or hospital could very likely send out four different appointment reminders addressed to the minors in the house. But with an EMPI that can recognize when patients have the same last name and same address, savings can be achieved by sending out only one direct mailer, to one of the adults in the household.
- Billing errors—Without accurate address information that can differentiate the Mary Jones on Main Street from the one on Park Avenue, or combine the records for John Smith who sometimes goes by Jack Smith, the potential for billing errors is high. Patients can be billed either too much, too little, or not at all. Similarly, duplicate records or inaccurate demographics can affect billing for insurance companies. This compromises revenue integrity and leaves “money on the table” in a lot of cases.
Operating without a strong EMPI in place has the very real potential to negatively affect patient outcomes; studies have shown that four of every 100 cases involving duplicate records have a negative care impact, and that more than 100,000 people die annually because of identity or "wrong patient" errors. In addition to patient outcomes, the financial risk is great as well; a study of one hospital in Texas showed that duplicate records made up 22 percent (250,000) of its records, and that each of those records was costing the hospital more than $96. With these alarming statistics, it’s critical that hospitals look at the risk-benefit ratio of operating without a next-generation EMPI and make the right decision for both the patients and the business.
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