Evaluating and Addressing the Need for an Effective EMPI

The impact of inaccurate patient identification on a healthcare organization and its patients is wide-spread and significant. An inefficient master patient index results in duplicate and/or overlaid patient records. It can also result in inappropriate, delayed treatments, or other adverse events.

This, in turn, can create a life-threatening situation due to inaccurate medical records and clinical information at the point of care. An inefficient MPI also increases the workload for health information management and IT in terms of managing system integrity and creates a significant drain on financial resources.

Industry-wide estimates are that 5% to 20% of a hospital's records are duplicates. That rate increases to 40% or higher for organizations that have acquired and/or merged with other facilities or are part of an integrated delivery network. Each duplicate record carries direct costs ranging from $20 to identify and correct it to several hundred dollars in variable costs for repeated diagnostic tests when a patient's record cannot be located in a timely fashion.

Why an EMPI?
Multiple MPIs that are not linked across an enterprise can result in data being entered into multiple records for the same patient, with no ability to merge those records until post-discharge or sometimes not at all. This leads to inconsistencies and inaccuracies that impact care decisions. It can also affect the interoperability between and among a facility's information systems and those of its partners and affiliates.

These were the challenges Exempla Healthcare, which includes three hospitals and a network of clinics throughout the Denver metro area, was determined to overcome with the implementation of an enterprise master patient index.

In addition to the need to mitigate the risks created by an ineffective MPI, a primary driver of Exempla's push for EMPI was its migration to Epic. As part of that process, data would be aggregated from two MEDITECH systems and one Kaiser Permanente-hosted Epic system into a single Exempla-wide Epic system.

Exempla's objectives with its EMPI project were to:

• Enable clinicians and physicians, including those from affiliated external provider entities, to accurately identify patients throughout the enterprise and provide them access to pertinent clinical information regardless of where the patient received clinical services within Exempla.
• Provide the clinician/physician with a complete view of a particular patient's health status.
• Adopt an advanced record search algorithm to enable patient registration and scheduling staff to more accurately identify patients and reduce the risk of incorrect patient identification and duplicate record creation.

A fourth goal was to reduce the cost Exempla was already incurring related to duplicate records. Estimates placed the duplicate volume for all three facilities at more than 17,000 records. Of those, an estimated 4.3% incurred additional clinical costs averaging $205.38 for repeated tests and treatment delays and incremental costs of $2.50 for additional registration times and $20.63 for correction. As a result, the total annual cost to the Exempla system for duplicate records was estimated at $554,000.

Industry reports have cited much higher clinical and treatment costs associated with unavailable historical medical information; in the neighborhood of 20% to 30%. This higher estimate would place Exempla's total annual cost in excess of $1.2 million.

Expectations were that the EMPI would reduce duplicate records by 70% after the first year. This would result in a return-on-investment within two years due to reduced costs in management of patient data, a reduction in the variable costs for duplicate tests, and elimination of on-going costs associated with resolving duplicate records.

Setting the Standards
Accomplishing these goals and objectives required Exempla to first determine whether an external EMPI was even necessary in light of the pending migration to Epic. They also needed to establish a clear understanding of key areas of weakness and set expectations for whatever EMPI solution was ultimately selected.

Recognizing that these critical tasks required a depth of experience and proven expertise that was not available in-house, Exempla engaged Just Associates, a consulting firm specializing in data integrity, to evaluate its strategic needs related to interoperability and an external EMPI. The firm was also charged with establishing a standard set of requirements to evaluate potential vendors.

This process started with a comprehensive data integration and patient identity data capture assessment to identify specific needs. Individuals involved in registration and scheduling were interviewed to gain a clear understanding of their work processes. Specifically, how pertinent information was collected from the patient, how that data was captured, how searches for existing patient records were conducted, and how that patient's identity was validated. Front-end search capability was evaluated in the registration and scheduling system with emphasis toward searching for records where multiple demographic data discrepancies might exist based on data being searched against what was stored in the database.

Next, back-end processes, namely the 200-plus system interfaces across which patient data was exchanged, were evaluated to ascertain how accurately the receiving system's record matching performed. Areas of potential risk were identified for each downstream system.

This led to the development of more than 250 functional requirements for prospective EMPI solutions. Among these were the ability to search on multiple data elements, identify individual records despite multiple data discrepancies, extensibility for future enhancements (including open source capability of the source code), and ease with which data could be extracted from the database for reporting. System requirements were also identified, including interoperability with the existing interface engine operating system and database platform, system scalability, response time metrics, etc.

Other specific requirements for the prospective EMPI solutions included:

• Ability to support patient conversion from legacy systems into a single Epic system
• The ability for Exempla to manage content across multiple data sources
• Be able to integrate with Exempla's ambulatory EMR strategy
• Open architecture system for extension needs
• Ability to integrate bi-directional feeds with other ambulatory EMRs
• Ability to easily integrate with Exempla's integration engine

Justifying Costs, Establishing ROI
These requirements ultimately drove vendor selection. However, to validate that selection and to secure approval and funding to move forward with implementation, a total-cost-of-ownership and ROI analysis was conducted.

The goal was to provide not only the cost justification, but also an explanation of goals and the consulting hours needed for EMPI implementation. It also served to identify general interoperability with and without EMPI implementation, and duplicate vulnerability for downstream systems in the absence of an EMPI.

The analysis was highly detailed and included:

• Ability to support patient conversion from legacy systems into a single Epic system
• The ability for Exempla to manage content across multiple data sources
• Be able to integrate with Exempla's ambulatory EMR strategy
• Open architecture system for extension needs
• Ability to integrate bi-directional feeds with other ambulatory EMRs
• Ability to easily integrate with Exempla's integration engine

An educational component was also developed to help the capital approval committee understand that EMPI is more than just a filter to identify duplicate records; it is a complete data management tool designed to improve patient safety through delivery of accurate information.

A Blueprint for Long-Term Success
Exempla's EMPI project is currently in the implementation phase, but the organization is already realizing the benefits of conducting the comprehensive assessments, evaluations, and justifications that led to the decision to move forward.

That is because the thorough analyses did more than validate Exempla's need for an EMPI. By identifying the weaknesses in the existing collection and maintenance of patient data, Exempla was able to take corrective action even before implementation is complete. This will ensure that the organization realizes immediate benefits from the elimination of duplicates within the system.

More importantly, this approach ensures that the organization–and its patients–will realize the long-term benefits that come from the permanent resolution of those data integrity issues that would otherwise continue to plague the system and limit the effectiveness of EMPI.