April 1, 2018
By Gordon Cooper and Christie Scanlon
Original Article in HFMA.org
ONE HOSPITAL FOUND THAT DUPLICATES ACCOUNTED FOR 22 PERCENT OF ALL PATIENT RECORDS, RESULTING IN $96 IN ADDITIONAL COSTS PER DUPLICATE.
Duplicate and unmatched patient records in hospitals and health systems are likely costing those organizations more than they realize. Inefficiencies caused by duplicate records infect operations in numerous departments of hospitals.
Before developing solutions, healthcare leaders should consider several characteristics that determine useful data. For example, reliability, validity, and relevance are critical in our current era of big data, interoperability, artificial intelligence, and the Internet of things (IoT). One feature that isn’t always mentioned is “relatability,” but it is critical to high-functioning healthcare data systems. Do records relate to each other? If so, how, and what real-time or near-real time decision can be based off this information?
Some hospitals and health systems are tackling this challenge by implementing enterprise master patient indexes (EMPIs)—databases that maintain information on registered patients across various facilities—to address duplicate and incomplete patient records. EMPI’s allow a single view of patients that ensure patient safety and provide a solid justification for the necessary investments in staff time, services, and information systems.
Areas of Cost Impact
In hospitals without effectively implemented EMPIs, rates of duplicate patient records vary widely, but can be surprisingly high. For example, one Texas hospital found that duplicates accounted for 22 percent of all patient records. And costs resulting from inefficiencies associated with those duplicate records were calculated to amount to $96 per duplicate (Lusk, K., “Duplicate Records Compromise EHR Investment,” hfm magazine, August 2009). The inefficiencies of duplicate patient records impact hospitals in five areas.
Patient registration. During registration, hospital staff might see a name and a partial address, but do not have a complete enough view of the patient who just walked in to determine whether it’s the same patient who had X-rays last week or just someone with a similar name (e.g., Kelley Smith vs. Kelly Smith, or Mary Jones on Oak Ave. vs. Mary Jones on Oak Rd.). The information is incomplete and siloed from department to department within a hospital or health system; each department may have entered the information differently, inaccurately, or incompletely. Without an EMPI or similar data management system in place, there is no central repository that contains all the disparate information and no way for one department to “talk” to another to verify information.
Incomplete patient information leads to slow, inefficient registration processes that take more time, compromising the revenue potential of your organization. Add to this the additional cost in wasted time and resources for staff to retrieve, compile, and properly aggregate multiple records.
Patient accounting. On the back end, consider billing staff who are sorting through disparate data that has been compiled from different touchpoints within organizations (e.g., emergency department [ED], pharmacy, and admitting). They must work to discern what information goes with which records so they can send the right bills to the right patients or providers for the right amounts. This is not an automated, rules-based process, but a manual process, prone to human error and oversight.
Clinical errors. Incomplete information resulting from duplicate or partial records can contribute to clinical errors. For example, providers without access to single, complete patient records may be in the dark about the medications their patients are taking. This can lead to duplicate medications being prescribed as well as potential adverse events resulting from dangerous drug-to-drug interactions or drug allergies that may have been documented in one system but are missing from others.
In many of these cases, hospitals will bear the cost of additional care to address these complications without additional revenue. The cost of clinical errors can reach far beyond immediate operational expenses as a result of low patient satisfaction, decreased employee and physician satisfaction (i.e., turnover cost), and heightened litigation risk.
Unnecessary care. Without an EMPI to help eliminate duplicate records, patients can be sent for tests they’ve already had. Consider a patient who first visits the ED 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 ED just two weeks earlier and may order costly duplicate testing. Or, a patient may have multiple chronic conditions, and each specialist he visits orders similar sets of lab and radiology tests that are unnecessary and inconvenient for the patient. In the past, fee-for-service payments would cover these costs, but with fixed payments from episodic bundled payments and other value-based payment models that transfer risk to the provider, hospitals will increasingly bear these costs themselves.
Patient satisfaction. So many of these issues—from billing errors to repeat tests to inefficient check-in and administration processes—can lead to negative experiences for patients or their loved ones and caregivers. Increasingly, high copayments and deductibles are making patients more sensitive to billing issues than ever. And in a world where patients as consumers have a voice now more than ever as a result of social media, negative reviews can spread like wildfire.
Enough bad experiences translate into a bad reputation, leading members of a community to take their business elsewhere. These days, patients also realize that healthcare is a business, and to the extent that they have choices in a market, they will take their business to someone they trust.
Reduce Duplicates with an EMPI
In choosing an EMPI solution for your organization, several factors must be considered. Look for a solution that can be scaled across the organization and offers the following elements:
- A single installer, ensuring you can start ingesting data quickly
- An approach to product design that allows the organization to move toward full independence quickly
- Easy-to-configure matching rules that enable you to monitor the health of the system
Once you’ve selected the best solution, work with your EMPI partner to decide which data sources to bring into the new system, assess the quality of that data, and start matching patient records to identify duplicates and gaps in information. Once the data is in the EMPI system, you will be able to focus on ongoing data stewardship, managing your duplicates going forward.
Putting It All Together
Duplicate records infect many aspects of hospital operations with costly inefficiencies. These types of problems are only escalating with trends such as mergers between providers, payers, and even retailers such as CVS and Amazon. More disparate systems mean the care coordination mandated by value-based payment models will be more complicated than ever. There is a cost to not planning for these known inefficiencies sooner rather than later.