Data Integrity Matters Newsletter
October 2011 Vol 2
Executive Viewpoint
Incorrect or incomplete patient information isn’t just a nuisance; it is a serious patient safety issue with potentially fatal repercussions. The seriousness of this problem was driven home for me recently when news broke of two deaths resulting from data errors.
In one instance, a patient died after receiving therapy meant for someone else when the wrong name was entered on a record. In another, an infant died after the wrong dosage information was entered into an automated compounding system, resulting in the child receiving massive doses of sodium chloride. The latter situation was created by an integration gap between the hospital’s computerized physician order entry (CPOE) system and the machine that prepared the baby’s IV fluids that necessitated manual entry of the physician’s orders.
These tragic events drive home the point that data integrity is critical to ensuring patient safety. In both cases, had the information been correctly entered into the system, communicated electronically to the downstream system or discovered before treatment was administered, lives would have been saved.
For hospitals, ensuring that data is clean and accurate begins with examining the processes currently in place to identify areas of weakness that could result in incorrect information being entered into the system. Duplicate records and weak patient identification are two of the key areas that should be addressed. Once areas of weakness have been identified, hospitals must take steps to ensure that existing errors are corrected and that future ones are prevented.
In a world where patient records are increasingly created and retained electronically, data accuracy must be a top priority. With the proper steps and processes, hospitals can ensure that patients will receive the highest quality and safest care possible.
ACOs and Data Integrity: The Elephant in the Room
There has been no shortage of debate on what is required for accountable care organizations (ACOs) to achieve the cost and quality expectations placed upon them as central elements of healthcare reform. From business models to cultural changes to clinician and patient engagement to IT architectures, few stones remain unturned in the examination of ACOs since the Centers for Medicare & Medicaid Services (CMS) issued it proposed rules in April.
Yet there remains a very large elephant in the ACO living room, one that has been alluded to but never explored with any real depth: data integrity.
A core competency for any successful ACO is the ability to aggregate data from and share it across multiple sites and between multiple providers. This exchange of information is at the heart of an ACO’s ability to improve care and reduce costs. Yet few organizations are able to effectively maintain the integrity of the data within their own four walls. This is evidenced by the volume of duplicate patient records at a typical hospital, which is estimated to be anywhere from 3% to 15%. For facilities that have been acquired, merged with another facility or that are part of an integrated network, that volume can be 30% or higher.
The costs related to duplicate records can reach millions of dollars, due in large part to the redundant diagnostic procedures that are often necessary when the correct patient record cannot be located in a timely manner. This repetitive testing can add up to 30% to clinical costs. It can also delay diagnosis and treatment and increase registration and admission times.
As significant as the impact a high volume of duplicates is on quality, safety and cost at an individual provider organization, it grows exponentially as that data flows into an ACO and mingles with equally questionable information from other participating organizations. Left unchecked, these data integrity issues can hinder an ACO’s ability to demonstrate improved quality outcomes and cost reductions. Subsequently, they can hinder its ability to qualify for shared savings payments.
For ACOs, the solution could be as simple as mandating that any organizations wishing to participate be able to demonstrate that its duplicate volume does not exceed a mutually agreed upon maximum. This helps ensure that providers are not missing bonuses or being penalized because a high number of duplicate records forces them to order repetitive tests or make care decisions based on incomplete information.
However, responsibility for data integrity doesn’t lie solely with the hospital or other participating provider from which that information originates. The ACO leadership must also commit to investing the resources into ensuring that patient records remain as close to duplicate-free as possible. This requires more than just technology; it requires bringing in the expertise necessary to identify weaknesses and implement processes to ensure the date flowing into the initiative is clean … and stays that way.
Outsourcing MPI Management
Advances in remote connectivity and the growing recognition of the role eliminating duplicate records plays in increasing safety and quality and reducing costs have resulted in more hospitals considering outsourcing management of their master patient index (MPI).
Outsourcing makes sense, given the role effective MPI management plays in any hospital’s data integrity strategy. For starters, a well-managed MPI ensures that patient information is clean and accurate, increasing quality of care and reducing administrative costs. It also plays an integral role in a hospital’s ability to efficiently achieve meaningful use.
However, despite the numerous benefits that can be realized from an effectively managed MPI, many hospitals face significant obstacles in achieving the necessary level of efficiency in the process. These include (1) dedicating the necessary resources and (2) finding an effective and efficient way of eliminating existing issues and reducing the likelihood of future ones.
Outsourcing MPI management can address these issues while increasing productivity, efficiency and accuracy. It can also position hospitals to maximize the impact of their IT initiatives at multiple clinical and operational levels.
Outsourced service providers offer the expertise to clean historical data and provide advanced workflow software to validate and reconcile duplicates. Leveraging such advances as cloud technology, software as service (SaaS) and improved interfaces, they can also provide ongoing monitoring to ensure the MPI stays clean.
In fact, ongoing monitoring is the real value of outsourced MPI management. It can be done as frequently as a hospital needs and allows any new issues to be identified and eradicated before they affect data integrity. It also frees internal health information management (HIM) staff to handle higher-priority areas of patient safety and data management.
Further, outsourced MPI management teams can provide detailed, actionable data integrity reports that pinpoint weaknesses in the system or individuals who require additional training, thus mitigating the risk of future problems. The resultant improvements can also help hospitals comply with multiple mandates and improve the revenue cycle by ensuring clean and accurate data is used for all billings and claims. Finally, a clean MPI streamlines and accelerates multiple workflows, including clinical and registration, increasing patient and physician satisfaction and reducing costs.
Given its financial and clinical benefits, it makes sense that outsourcing MPI management is emerging as a solid strategy for achieving the highest level of data integrity. It offers a cost-effective and highly efficient way to ensure patient data is clean, accurate and available when needed for clinical decision making.
Insider Information
WellSpan Health recently discovered one of the hidden benefits of working with a firm like Just Associates, which possesses deep knowledge of many of the industry’s leading clinical information systems. That knowledge often translates into new ways to improve or maximize system performance.
Notes WellSpan Senior Project Manager Eric Droege Jr., PMP: “Just Associates was able to guide us through configuration changes that improved the performance of our Cerner Millennium system. In one such instance, Cerner was retaining the ‘retiree MRN’ in the PowerChart banner. Just Associates recommended a change to the ‘Encounter Level MRN Combine Action’ setting that resulted in the proper ‘survivor MRN’ to be displayed. This code change reduced the merge process time and eliminated the need to manually move encounters to the survivor’s record. Just Associates’ knowledge of Cerner’s systems was beneficial and was demonstrated throughout the cleanup project.”
Around the Industry
Fatal Errors Spotlight Importance of Accurate Data Entry
A number of fatal errors and near misses have the healthcare industry up in arms over the accuracy of patient information and the use of technology in the field, placing further emphasis on the need for clean and accurate data in the patient-care setting. According to the U.S. Food and Drug Administration (FDA), 370 reports of problems involving health information technology were filed in 2008 alone. These include one patient dying after receiving therapy meant for someone else after a wrong name was entered electronically on a scan performed by radiologists.
CMS to Test E-reporting of Quality Measures
Hospitals participating in the Medicare Electronic Health Record (EHR) Incentive Program now have the option of reporting clinical quality measures through an electronic reporting pilot rather than by attestation. That is according to the Centers for Medicare & Medicaid Services (CMS), which released a rule in July that included the reporting pilot as one of the provisions. The pilot is designed to advance the use of an electronic infrastructure that supports the use of EHRs by hospitals to meet various quality program requirements, including meaningful use.
Number of HIEs Doubled Since 2010
The number of operational health information exchanges (HIEs) has increased twofold since last year, with private exchanges expanding more rapidly than public organizations for sharing information, according to a recent report from KLAS. Since last year, the number of public HIEs has expanded from 37 to 67, while private-sector HIEs have surged from 52 to 161. KLAS believes the slower establishment of public HIEs may be due in part to government oversight and ensuring long-term funding.
HHS Targets Medicaid Costs With New Coordinated Care Models
The U.S. Department of Health & Human Services (HHS) has announced new demonstration projects addressing financial models for coordinated care, aimed at reducing Medicaid spending and improving care. Currently dual-eligibility beneficiaries, such as patients with diabetes, depression, hypertension and a history of strokes, must navigate two programs, creating fragmentation and increasing costs. However, under CMS Innovation, these new financial models are expected save money and ensure quality of care.
Survey Reveals Increased Information Sharing, Privacy Controls
Sharing of patient information between physician offices, laboratories and hospitals has increased nationwide despite patient concerns over the safety and security of their personal information, according to the eHealth Initiative (eHI) annual survey of HIE. The eHI 2011 Report on Health Information Exchange: The Changing Landscape, which was released in July, reveals that initiatives are actively developing privacy controls for patients in the absence of new federal requirements. It also found that, in addition to struggling with business models and values, groups are facing new challenges related to technical aspects and systems integration. Finally, the survey found that the majority of advanced initiatives are offering at least one service that supports meaningful use requirements.
Just Associates News
New Faces
Just Associates is pleased to welcome Deborah Burnett to the team. As chief information officer (CIO), Deborah is responsible for overseeing all of the firm’s IT efforts, including product development for IDMaster® and development and implementation of IT infrastructure standards to support the Just Associates’ business mission.
Sharon Regional Signs On for Repair™
Sharon Regional Medical Center has expanded its relationship with Just Associates to include Repair™, the firm’s remote master patient index (MPI) cleanup service. Available as part of Just Associates’ comprehensive outsourced patient identity management suite, Repair leverages the firm’s highly trained staff and proprietary IDMaster® Duplicate Workflow Software for cost-effective management of the duplicate validation and reconciliation process. By outsourcing the daily management of its MPI to the data integrity experts at Just Associates, Sharon Regional benefits from a more efficient duplicate record resolution process and gains relief from the staffing headaches and resource limitations that impact many hospitals’ efforts to attain and maintain a clean MPI.
New White Paper
Just Associates recently released “Outsourcing MPI Management to Reduce Costs, Improve Data Integrity,” a white paper that takes an in-depth look at the factors driving the emergence of outsourced MPI management and its benefits. It is available on the firm’s website.
Beth Just Speaks at CHIMA
Just Associates President and CEO Beth Just shared her insights into data stewardship at the Colorado Health Information Management Association (CHIMA) Technology Committee’s 2nd Annual Data Integrity Summit in August. The presentation, “Data Stewardship — Key to Building Transparency and Trust in the EMR,” focused on how electronic medical record (EMR) systems provide tremendous opportunity for improving the quality and efficiency of healthcare but are also creating unexpected and difficult challenges that can impede improvements in ways that may actually cause harm.
Beth also participated in a joint presentation with Exempla Healthcare Health Information Management (HIM) System Director Karen Proffitt on the same topic during the CHIMA Spring Conference & Annual Meeting in May. In addition to the opportunities and obstacles presented by EMRs, Beth and Karen discussed electronic documentation challenges, their impact on the legal health record and HIM’s vital importance in the development of EHRs and the governance and policy development in their use.
Just Associates in the News
Beth Just shares with readers the key role that outsourcing MPI management plays in reducing costs and improving data integrity in her Executive Insights article, “Outsourcing MPI Management.” The topic is also examined in her Healthcare Technology Online column, “The Emergence of Outsourced MPI Management.”
The impact duplicate records can have on achieving meaningful use is the focus of Beth’s Western Pennsylvania Hospital News article, “Eliminating Duplicate Records to Achieve Meaningful Use.” She is also quoted as part of a Healthcare Finance News feature, “Economy, Technology Altering Healthcare Job Demand,” and discusses data integrity and health information exchange issues related to accountable care organizations (ACO) formation with Healthcare Technology Trends in “ACOs: Show Us the Data.”
Finally, Gwyndle Kravec discusses the process taken by Peninsula Regional Medical Center, and the role played by Just Associates in its success, to transition from social security numbers to unique medical record numbers in the Healthcare Informatics article, “Protecting Patient Identity.”
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