Duplicate-detecting algorithmic technology is generally known as enterprise master patient index technology. "It's all matching on information that you have on the patient, so name, address, telephone number, cell phone number," Richards says. "There are algorithms that run that give you a score of how sure the system is that this is the same person coming from multiple different institutions."
Geisinger is a textbook example of why, in the EHR age, EMPI is still in use. "Epic's master patient index works very well in the Epic world, which is in our case pretty big," Richards says. "We have about 9,500 users on any given day using the Epic system. We have their inpatient/outpatient, many of their specialty modules—ED, OR. We probably run 12 or 15 of their software modules here, and they have very good master patient index for all those. It will track multiple medical record numbers from different sources."
But when Geisinger first installed Epic, it didn't reconcile Epic medical record numbers effectively with other external systems in use, not only within its provider system but now increasingly with its health information exchange. "So let's say that we purchase a hospital that has another billing system or another lab system or something," Richards says. "Epic, at least as we installed it originally, was not capable of taking calls from an external system, reconciling the numbers in its database, and interacting with that system," Richards says.
So, for the past 15 years and continuing today at a cost of $1 million a year, Geisinger maintains an EMPI separate from Epic to reconcile the non-Epic patient identifiers.
"We'd need an army of people to check every one of these, so it's well worth it," Richards says. "So once I've identified that person A from hospital X is the same person from Geisinger, I'll then capture their identifier, their medical record number, from hospital X and so I'll have that forever, and so the next time I don't have to match on all of these parameters. I know that this person coming from this organization has this patient identifier. Over time, it gets more efficient."