Contributions by:Deb Cockroft

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Dont Get Dupd Understanding the Cause, Effect
and Prevention of Duplicate Medical Records
Presented by John Danahey
Contributions by Deb Cockroft Cheryl
Martin Hunter Merritt
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Agenda

• Presentation Approach
• How big of a problem is it?
• What are the causes?
• What are the costs?
• How do we prevent future duplicates?

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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
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What Problem?

• Average duplication rate is 5 -10 up to 25
  for IHDNs.2
• somewhere between 3 to as high as 153
• 150,000 (out of 787,000) possible duplicates at
  WA based healthcare system.4
• at least 5 percent of the records5
• sometimes approaching 10 to 15 percent6

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Interesting Study?
Record Size Duplicate
lt300,000 4.9
300k 500k 7.4
500k 800k 6.2
800k 9.8
Based on the study of 70 facility level MPI
files.7

• Conclusions
• 5 - 10 Average Facility Duplication Rate
• The larger the facility, the higher the potential
  for duplicates
• IHDNs have greater potential for duplicates

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Causes
What are the causes of duplicate medical
records?
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Causes

• Mergers
• Overlap Populations
• Human Errors - Staff
• Typos
• Misspellings
• Poor training
• Performance Anxiety

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Causes (cont)

• Human Errors Patient
• Poor Historian
• Use of Nicknames
• Name Changes
• Hospital Processes
• Decentralized Registration
• Reference Lab Specimens
• Physician Office EMR Integration

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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
• Rules-based algorithms (Soundex) with a 50-80
  accuracy.9

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The Problem with Soundex
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Costs
What are the costs associated with duplicate
medical records?
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Clinical Costs

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

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Direct Costs

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

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Legal/Regulatory Costs

• JCAHO requirements for single, unique identifier
  readily available for patient care10
• HIPAA Administrative Simplification
  Individual Identifier.
• CMS/OIG/Other Payers- 72 Hour Rule- Medical
  Necessity Frequency Requirements
• Legal Liability due to Compromised Patient Care

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Actual Dollars

• can be a minimum of 50 per pair.11
• at least 25 per record.12
• 25 to 400 per duplicate set.13
• Hospital Study Average time to find, clean and
  merge was 30 to 45 minutes.14
• Conservative Cost Model 19.8215
• 20 to several hundred dollars.16

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The CFO View
Conservative Estimates Average Duplicate Rate
5 Average 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
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Some Observations

• 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.
• There is a cost for doing nothing.

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Preventing Duplicates

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

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References
1. Hewitt, Joseph B. and OConnor, 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.justasso
c.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
OConnor. 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.
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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/resou
rces/exec_summary/38/Medical_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/arc
hives/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?P
ageh0302toward.htm. 15. Fernandes et al.
Medical record numbers errors 16. Just
Associates, Inc. Industry Problem 17. Fernandes
et al. Medical record numbers errors
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Thank You John Danahey Vice President Customer
Services Division Phone [phone] Email
JohnD_at_iatric.com http//www.iatric.com