Diminishing the Impact ofDuplicate Records and Fraud forPatient Safety & Quality of Care                               You...
Agenda1   Patient Access Personnel: Key Team Member2   Objectives of Patient Access Personnel3   Goal: MPI Integrity Manag...
Patient Access Personnel:Key Team Member
Objectives of Patient Access PersonnelRequirements & Solutions              Requirements & Solutions1                     ...
Goal: MPI Integrity Management    One Patient Identity     Authenticate             Accurately authenticate1     Patient’s...
Causes of Poor MPI Integrity    Human Factors           Registration is challenging, staff turnover is high1           P...
How Big is the Problem?                              Duplicates/Overlaps costDuplicates and Overlaps             $100 or m...
What is the Impact    A Patient’s Perspective            A Physician’s Perspective   Registration Delays                ...
Techniques to Resolve Duplicate Records, Overlays and Fraud                       Raise organizational awareness and prop...
Simplicity to SucceedUsing Procedures & Technoligy to Simplify Complicated Processes                             Incorpora...
THANK YOU!         HIMSS Information, Articles and Resources in Following Slides.              This presentation is for ed...
HIMSS                Patient Identity Integrity       PI Integrity is the accuracy and completeness of dataattached to or ...
HIMSS                Patient Identity Integrity       Because of its potential for impacting quality of careand patient sa...
Articles and Resources   http://www.justassociates.com/Practice-Briefs.html           (AHIMA practice briefs -focus on MP...
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National Association of Healthcare Access Management Presentation

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National Association of Healthcare Access Management Presentation.

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  • It is time to review current policies and procedures and take appropriate steps to ensure patient safety
  • MPI = Master Patient Index
  • Patient Access is the frontline to help ensure patient safety and identity is accurate and to link all patients to their correct medical record upon admissions or check-in. We must provide bullet proof procedures and technology to safeguard and support frontline…Patient Access personnel success.
  • We need to avoid moving our paper record problems into the electronic world as we implement EMR. These processes are an ongoing management of knowledge and human resources. Automating processes helps to manage keystroke and interaction errors.
  • An accurate MPI, whether in paper, electronic or somewhere in between, may be considered the most important resource in a health care facility, according to AHIMA Practice Brief Maintenance of Master Patient Index (MPI). According to a poll in the Dec. 3, 2007 issue of ADVANCE when asked "Does your office or facility have a process in place to help prevent duplicate medical record numbers?" Half of the respondents either said no (17 percent) or they weren't sure (33 percent).
  • Process involves many touch points where errors may occurWorkload impact and down-stream effectsTime constraintsLimited patient identification information (wrong information starting from physicians)Negative economic conditions may result in patients accessing healthcare services by assuming another person’s identity (identity theft; uninsured) Errors may multiply because the wrong information is accessed repeatedly and new errors may be createdThe larger an institution’s database, potentially the higher the percentage of duplicates A growing database implies more human interaction and decision making, which may lead to more data errors and variationsFixing the problem requires changes to existing processes that may cross a multitude of departmentsUnwillingness and resistance to process change or inability to change processesDelayed discovery of problem – sometimes involving accounts with multiple transactions in the interim, all of which must be investigated and resolved
  • Studies done by Just Associates and Quadramed (2 companies specializing in Master Person Index Integrity)Overall (2001-2008)Average MPI size - 708,499Highest Dupe Rate Single Facility- 57.7% Highest Dupe Rate Overlap - 73.4%Lowest Dupe Rate - 0.1%
  • Information from: survey conducted in preparation for Electronic Medical Record (EMR) by an individual Hospital
  • The longer an error exists, the worse it can get. Dups – bouncing ball… lab uses one record, radiology uses another – repeatedly – then patient admitted…Overlays – if not caught and corrected on a timely basis more and more clinical information will be commingledThis process is more commonly used when there is an overlay than a duplicate or a overlap; the risk with those is so grate that they need rapid resolution!*Patient Identity Smart cards and Biometric solutions are proven to help accurately identify each patient for each visit, automate the registration process and diminishes duplicate records, record overlays and patient fraud.Smart Cards Benefits:Proven sustainable model, small investment and a prompt ROI Limited IT requirements (about 20-30 hours per HL7)One Identity Card correctly connects patient to all their Medical Record Number’s Identity Card automatically evokes the correct medical record using current registration software (no key strokes)Streamline Registration and Insurance Verification Process (Patient Satisfaction)Diminish multiple identities, duplicate records and identity fraudAccurate billing and claims processing reducing days outstanding of Accounts ReceivableOptional: Real-time payment of co-pay, deductible with debit, HAS or VisaLinks multiple and disparate providers MRN’s to one verifiable IdentityBranded Identity for Patient Loyalty and Community EngagementBiometrics BenefitsFinger or Palm Vein correctly identities Patient within the providers locations and those aligned with the same database and Biometric solutionPatient record access with applying palm to a readerHarmless near-infrared lightPatients will always have them, no risk of leaving at home
  • Educate staff, incorporate procedures & technology to simplify and help ensure standards are in place to reduce the risk of errors and implement a plan to provide continuing education, review new technology and measure ongoing results throughout all departments
  • Disclaimer:These are offeredresources only and may be used as a starting point of research, reference and industry materials. It is strongly suggested to research all possibilities available prior to determining a solution.
  • Reference
  • Reference
  • Disclaimer:These are offeredresources only and may be used as a starting point of research, reference and industry materials. It is strongly suggested to research all possibilities available prior to determining a solution.
  • National Association of Healthcare Access Management Presentation

    1. 1. Diminishing the Impact ofDuplicate Records and Fraud forPatient Safety & Quality of Care Your Logo
    2. 2. Agenda1 Patient Access Personnel: Key Team Member2 Objectives of Patient Access Personnel3 Goal: MPI Integrity Management4 Causes of Poor MPI Integrity5 How Big is the Problem6 What is the Impact✓ What are Solutions78 Simplicity to Succeed9 HIMSS Information, Articles & Resources Nancy Farrington, CHAM Based in part with NAHAM Special Projects, Policy Development and Government Relations Committees
    3. 3. Patient Access Personnel:Key Team Member
    4. 4. Objectives of Patient Access PersonnelRequirements & Solutions Requirements & Solutions1 2 Accurately Identify every  Practice techniques for patient to their Medical Record reducing the creation of dups for each visit or procedure as well as techniques to across the system identify & resolve them Continuing education of  Review the adoption of common causes, complexity industry Technology for the and impact of duplicates & automation of patient identity overlays on patient safety and and registration processes cost containment
    5. 5. Goal: MPI Integrity Management One Patient Identity Authenticate Accurately authenticate1 Patient’s Identity patients identity for each One Medical Record visit or procedure and2 Always Link Patient to Correct Medical Record correctly link patient’s to Technology their medical record Explore technology to3 help manage one unique patient identity across the Enterprise for enterprise access
    6. 6. Causes of Poor MPI Integrity Human Factors  Registration is challenging, staff turnover is high1  Poorly defined, un-enforced standards  Emphasis on speed, throughput  Insufficient training on impacts Historical Information System Limitations2  Poor patient query tools, insufficient error reporting  Search results ambiguous, non-intuitive  Corrective measures difficult to perform Other Factors  Past System/MPI Data conversions3  Decentralized registration  Reference Labs, “temporary registrations”
    7. 7. How Big is the Problem? Duplicates/Overlaps costDuplicates and Overlaps $100 or more Overlays: Catastrophic1 2 3 Industry estimate 8% to  Time & materials  Risk of Clinical Error 12% of a hospital’s wasted by researching,  Potential records are duplicates identifying & correcting confidentiality Rates may rise to 20% “on demand” (in breaches or more for multiple downstream systems)  Cost of litigation organizations that have acquired or merged  Duplicate testing with other facilities  Delays in billing & A/R Your Organization? (72 hour rule)
    8. 8. What is the Impact A Patient’s Perspective A Physician’s Perspective Registration Delays  45% routinely found duplicate Blood sample taken again for medical record numbers repeat test  30% re-ordered tests due to Medication changed after inability to find results in record organism ID’d on 2nd test  25% felt duplicate records Sick for additional 2 days— impacted the quality of care missed work, lost wages they were able to deliver Need to clarify billing with  Lack of Confidence in your insurance company organization Dissatisfied Patient
    9. 9. Techniques to Resolve Duplicate Records, Overlays and Fraud  Raise organizational awareness and propose solutions Identify Process  Create corrective action plans and execute proceduresImprovements for  Identify common issues, document and educate Targeted Areas  Analyze all calls (to Help Desk, Call Center, etc.)  Utilize reports (Distribute auto and manual combine reports to management and team on a regular basis)  Research with your IT Department for technology solutions Consider  Review Patient Identity Vendors using Biometrics* and/orUtilizing Vendor Smart cards* Products…  Schedule webinar & follow up on-site demonstrations  Schedule site visits with vendor clients
    10. 10. Simplicity to SucceedUsing Procedures & Technoligy to Simplify Complicated Processes Incorporate Implement, Educate Procedures & Train and Technology Measure
    11. 11. THANK YOU! HIMSS Information, Articles and Resources in Following Slides. This presentation is for educational purposes only.Nancy Farrington, CHAMBased in part with NAHAM Special Projects,Policy Development and GovernmentRelations Committeesfarringtonn@mlhs.orgwww.NAHAM.org
    12. 12. HIMSS Patient Identity Integrity PI Integrity is the accuracy and completeness of dataattached to or associated with an individual patient. Data mustbe reliable, reproducible, and sufficiently extensive for matchingpurposes. Completeness refers not only to having adequate dataelements present but also the correct pairing or linking of allexisting records for that individual within and acrossinformation systems. PI Integrity is of central importance toachieving quality of care, patient safety, and cost control2009 Healthcare Information and Management Systems Society (HIMSS)
    13. 13. HIMSS Patient Identity Integrity Because of its potential for impacting quality of careand patient safety, patient identity management is a longstanding challenge in the health care organization,provider office, or anywhere patient databases arecollected. The increasing penetration of technology intothe healthcare environment only exacerbates the problem.http://www.himss.org/asp/topics_Piitoolkit.asp
    14. 14. Articles and Resources http://www.justassociates.com/Practice-Briefs.html (AHIMA practice briefs -focus on MPI) http://www.azumc.com/body.cfm?id=872 (from University of AZ Medical Center – presented as method to encourage wide reporting of duplicates) http://health-information.advanceweb.com/editorial/content/editorial.aspx?CC=151146 http://www.himss.org/asp/topics_Piitoolkit.asp http://www.smartcardalliance.org/pages/smart-cards-applications-healthcare  Information on Smart card industry within healthcare www.lifemedid.com  Patient Identity, automated registration and Smart card vendor (White Papers, Support Materials) Nancy Farrington, CHAM Based in part with NAHAM Special Projects, Policy Development and Government Relations Committeesfarringtonn@mlhs.org www.NAHAM.org

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