The Impact of Duplicate Medical Records and Overlays in Healthcare


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Duplicate medical records and overlays continue to be two pressing issues for the healthcare industry as we usher in the age of electronic medical records, health information exchanges and integrated delivery networks. Although these two issues can seriously jeopardize patient safety, increase the likelihood of unnecessary treatments and a misdiagnosis, raise the cost of care, and have a detrimental effect on the revenue cycle for medical facilities, they are different in size and scope and until only recently, have not been getting the attention they deserve from C-level Executives.

We decided to learn more about what duplicate medical records and overlays are, their implications, how they are particularly troublesome and dangerous for children’s hospitals, what the real duplicate rates are at medical facilities versus what they report, the impact of these issues on revenue and the billing cycle, how duplicates and overlays affect data integrity and the effectiveness of health information exchanges, the amount of time needed to clean a database following the discovery of a duplicate or overlay, and what technologies are available to help stop them from happening from Beth Just, President and CEO of Just Associates, a Colorado based company that provides healthcare organizations with customized solutions that improve health data quality and result in enhanced revenue cycle efficiency, increased patient and clinician satisfaction and improved patient care.

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The Impact of Duplicate Medical Records and Overlays in Healthcare

  1. 1. M2SYS Healthcare SolutionsFree Online Learning PodcastsPodcast length – 52:39The Impact of Duplicate Medical Records and Overlays onthe Healthcare Industry with Beth Just, President and CEO ofJust Associates
  2. 2. Topics Covered in Podcast:What are overlays and how are they different from duplicatemedical records?What are the implications of overlays and duplicate medicalrecords and why do they pose a threat to patient safety?What is the actual % of duplicates and overlays at medicalfacilities vs. what industry experts say and why is there adiscrepancy?What impact to overlays and duplicates have on a medicalfacility’s revenue stream and billing cycle?What are the potential implications of duplicates andoverlays on healthcare data integrity and the ability to raisethe quality of care and lower costs?
  3. 3. Topics Covered in Podcast (continued):How much time and resources are needed to correct duplicatesand overlays? What additional steps are needed for prevention?What technologies today are predominantly used to eliminateduplicates and overlays and what others are viable solutions?What priority do hospitals place on addressing the issue ofduplicates and overlays?
  4. 4. • Overlays occur when two different patient records end up in one medicalrecord as opposed to duplicate records which occur when a patient isassigned more than one medical record numberWhat are Overlays vs. Duplicates and what are theirImplications?Implications:• Duplicates – patients are treated with missing information – could bedangerous (e.g. – incorrect blood types, severe allergies)• Previous tests can be missed – physician has incomplete information• Tests can be repeated – most common example was chest X-ray –this raises the cost of care and can be particularly dangerous (e.g. –unnecessary exposure to radiation in children)• Potential to have large financial impact on ACOs• Decreases available staff and resources to treat other patients• Delay in treatments
  5. 5. What are Overlays vs. Duplicates and what are theirImplications? (continued)• Overlays• Cause a huge patient safety risk – treating one patientwith another person’s record• Quality of care problems created are numerous and extremelydangerousDid you know?It can take over 100 hours to fix oneelectronic record overlay!
  6. 6. Why are Overlays and Duplicates ParticularlyTroublesome for Children’s Hospitals?• Higher risk for duplicates and overlays to be created at pediatrichospitals• Children can’t speak for themselves• Care giver may not know accurate demographic data of child (e.g. –DOB), child has no formal mode of identification• Can lead to adverse medications and duplicate diagnostic testsDid you know?Incorrect dates of birth are 10% more likelyto occur on pediatric records than on adultrecords.
  7. 7. Reconciling Duplicate/Overlay Estimates with RealWorld Results• Many industry resources (e.g. AHIMA) say hospitals average a 8% - 12%duplicate medical record rate• Rise of IDNs is exponentially increasing size of EMPIs and data indexesfrom disparate sources causing more overlays and duplicates• The actual duplicate and overlay rate depends a lot on how duplicatesand overlays are measured, based on the strength of underlying identityalgorithms – standard hospital information system versions are typicallynot strong – hospitals tend to know about just 20 – 30% of all duplicatesthat truly exist• Industry researchers tend to rely on more sophisticated, error tolerantidentity algorithms and provide more accurate measurement
  8. 8. Impact of Duplicates/Overlays on RevenueFee for Service:• Revenue impact centered on delays in issuing the bill due to problemswith demographic patient data integrity• Inability to combine bills for visits occurring within 72 hours riskingcharges of fraud from Medicare/Medicaid• Inability to identify patients who owe, or may have bad debtACO Model:• Larger impact and higher risk to providers and groups• Can’t longitudinally trend data for one patient to assess carereceived and determine proper course of subsequent care• Can’t accurately assess quality and effectiveness of servicesprovided• Inaccurate views of specific provider quality and efficiency
  9. 9. Impact of Duplicates/Overlays on HIEs*Typically, the larger the data set, the more duplicates and overlays that exist• Very few HIEs across the country have staff dedicated to measuring thequality of data coming into the system including the patient identity• Many HIEs lack data governance policies and those that do have littlepower to enforce them• Data tools used to collect, store, and disseminate information across HIEdon’t have strong record matching algorithms – creates problems ofoverlap with patients going to different hospitals and providers• Often times duplicates aren’t noticed until a provider starts searchingand pulling data from across the network• Overlays may be detected by providers but if not, significant patientsafety risks may occur• Many HIEs have greater than a 30% crossover (overlap) duplicate rate• Overlays and duplicates diminish the ability of HIEs to raise the quality ofcare – it decreases their value and the incentives for providers to join
  10. 10. • Easier to fix because most patient data software have utilities to allowstaff to merge and/or correct recordsAmount of Time Needed to Correct Overlays &Additional Steps Beyond Clean-UpDuplicates:Overlays:• Time to fix can range from an hour to months depending on complexity• Depends on EHR system and how easy it is to peel a record apart• The time the overlay has existed also affects how easy it is to correct• The number of providers touched by overlays also makes themcomplicated to correct• Staff must comb through note by note and result by result to correctrecord• Beyond correcting the overlay or duplicate, staff must be retrained andan auditing system created to establish accountability
  11. 11. Technologies to Eliminate Duplicates and Overlays• Record searching algorithms in patient scheduling and registrationsystems• More powerful the algorithm, less likely dups and overlays will becreated• Success of algorithm dependent on staff training, successfulunderstanding of how search functions operate, and how toeffectively evaluate & validate results• Biometrics for patient identification are increasingly used for accuratepatient ID• Streamlines registration• Significantly increases patient ID accuracy• Faster healthcare adopts, faster ROI will be realized• Studies show that regularly scheduled feedback to patient access staffwith examples of correct and incorrect patient data entries drasticallyreduces the creation of duplicates and overlays
  12. 12. Hospital Priority on Fixing Duplicates and Overlays• Greater awareness of duplicate problem at Executive and C-level thatthe problem even exists• Heightened activity in conducting master patient index (MPI) cleanups ofduplicates• Some EHR/EMR vendors mandate that medical facilities installing theirsoftware report duplicate thresholds before they can go live withdeployment• Meaningful Use requirements have indirectly spawned more attentionand action to reduce duplicates and overlays• Less attention at C-level for overlays, often times not recognized until anadverse event happens• Since most overlay discovery is anecdotal, it’s unknown how often ittruly occurs - there often isn’t the technology or processes in place tocatch overlays• Hospitals will start to demand more services and technology that reportpatient ID inaccuracies
  13. 13. The Value of Establishing a National PatientIdentifier (NPI)• As healthcare databases increase in size, the chances of duplicates andoverlays increases exponentially• Increased national attention on the importance of accurate patientidentification will bolster the call for an NPI• In the absence of an NPI it will be very hard and not cost effective toperform the level of data exchange created by EHRs and have patientstake ownership and control of their own care• NPI won’t solve the entire problem – there will always be theft,inadequate registration training, human error, and historical data errors inthe master patient index (MPI)• Despite having one, patients may not always remember to bring NPIwhen they seek healthcare
  14. 14. Thank you to Beth Just for her time andknowledge for this podcast!
  15. 15. John TraderPR and Marketing ManagerM2SYS Technology1050 Crown Pointe Pkwy.Suite 850Atlanta, GA Information