The Art of Mastering
Stephanie Middleton, Product Manager
April 15, 2010
Sentara Healthcare is a not-for-profit, fully integrated, regional health care organization that
provides health care services and health coverage in southeastern Virginia and northeastern
Sentara consists of more than 50 health care giving sites, made up of:
• 7 hospitals
• 10 skilled nursing and assisted living centers
• 23 primary care sites
• 2 integrated outpatient health care campuses
• Ground and air medical transport services
• Mobile diagnostic vans
• Numerous home health care services
• Fitness facility
• Community health education programs and other services and
facilities designed to create a lifetime continuum of care
In addition, Sentara offers several health coverage plans, including Medicare and Medicaid HMO
programs. Sentara introduced the area’s first HMO and is the leading provider of managed care
in the region. Currently, more than 330,000 people are covered by Optima.
In The Beginning…
In an attempt to unify patient Information into a single
system that can be accessed by an authorized user
from any computer, Sentara implemented CareVision
(CV) system. CV which was a portal for physicians to
access patient data via Sentara’s intranet or from their
office to view, sign and print reports.
• Duplicate patients in system.
• Physicians unable to locate patient data in central
• Physicians required to access multiple systems for
complete view of patient data.
A profound new development in patient care is taking place at
Sentara. It’s called Sentara eCare, a comprehensive electronic
medical record (EMR) system that allows consumers to access their
health records online. This revolutionary system was implemented in
February 2008 and links clinical information with scheduling and
registration data over a secure network. The enabling technology
allows the secure sharing of patient information across physical
boundaries including hospitals, physician offices, diagnostic centers,
and patients’ homes.
Laying the Ground Work
In preparation for our EMR, Sentara:
• Implemented an Enterprise Master Patient/Person Index (EMPI) in 2003.
Our goal was to reduce duplicate records in our patient database. At the
time of implementation there were 152,000 (5 %) duplicates in a patient
population of 3.1 million.
• EMPI was implemented in ―Passive Mode”. It was decided to deploy in
passive as we did not want to directly impact our HBOC registration or
scheduling pathway. Identification took place on the back end of the
Laying the Ground Work
• Thresholds were established whereby a person is automatically linked
with or merged to existing data. If the threshold is not met, the
registration data is held in a work queue for later resolution.
• Developed ―EMPI Team‖ that consisted of three employees dedicated
to duplicate clean-up and maintenance.
• Prior to 2006, patients who presented at the POS/POC received a MRN
equal to SSN. SSN is a poor identifier and increased patient
overlapping in EMPI. As of August 2006, all new patients received
system generated number of MRN.
What’s Ailing the EMPI
Overlays… oh my!
• Duplicate—more than one entry or file for the
same person in a single facility level MPI.
• Overlap—more than one MPI entry or file for
the same person in two or more facilities
within an enterprise.
• Overlay—one MPI entry or file for more than
one person (i.e., two people are erroneously
sharing the same identifier).
• Overlays were being discovered at an average rate of 1 per day.
• Prior to January 2009, overlay notification process was not clearly
defined. System/operational owners were not being notified in a
• EMPI not detecting overlays due to not enough information being
changed at one time (i.e. only name was changed, and no other
What is an Overlay
Two or more different people share the same patient
identifier (EMR, SID, CPI).
Birth Date: 1-13-1978
Address: 204 Hollow Point Dr. STOP!
Virginia Beach, Virginia 23452 Same EMR #
Birth Date: 1-13-1978
Address: 204 Hollow Point Dr.
Virginia Beach, Virginia 23452
• EMPI auto-link feature that automatically linked twins, jr/sr, and
mother/child. In 2007, auto-link feature was turned off due to incorrect
• Human error at the point of service.
– IDX registration
– Lab registration
– POA or ED registration
What We Found
EMPI APPS Team
Date 0-5 10-
System Date 5-10
15 Resolved Un-resolved
Overlay was Overlay EMPI Team hrs hrs
created in EMR: Created Notified of Overlay Comments:
IDX 62297460 3/19/2009 3/19/2009 x x
IDX 50248059 2/12/2009 3/19/2009 x
Cerner 72671136 10/10/2008 3/19/2009 x
Cerner 50393781 2/9/2009 3/19/2009 x
IDX 40127895 7/17/2007 3/18/2009 x x
IDX 40039379 3/3/2009 3/18/2009 x Overlaid twice
IDX 50666286 6/16/2008 3/17/2009 x x
Cerner 10104616 2/23/2009 3/16/2009 x x
IDX 62082140 8/27/2008 3/16/2009 x x
IDX 73026078 2/24/2009 3/16/2009 x x
IDX 68353 9/21/2007 3/16/2009 x x
IDX 16163 9/18/2008 3/12/2009 x x
IDX 63377077 1/26/2009 3/12/2009 x x
What We Did
• Developed overlay notification team which consisted of:
– IT System Owners
– Registration Managers
– EMPI Team
• Identified EMPI Med Sys Apps Support Team as system administrator for
notification system and process owner
• Setup method for alerting overlay notification team
– Paging group via telecommunication was setup to alert team of overlay
– Developed procedure to alert and communicate overlay status
• Created tracking and communication system for overlay team to
effectively tracking resolution
– Overlay repository was created through Share point for system owners to access
patient information concerning overlay and sign-off when complete
• Developed communication plan to clinicians and department leaders on
Ecare Alert Placed On Overlay
Getting Ahead of Issues
• Developed duplicated oversight committee.
• Identified need to deploy EMPI duplicated clean-up taskforce prior to
facility and physician practice implementation.
• Identified number of existing overlays (3,600) and estimated time (1 ½
years) required for overlay resolution.
• Hired five temporary to resolve overlays with expertise in each
downstream system affected.
• Implemented quarantine process.
• Communicated, communicated and communicated to clinicians,
department management and risk management on overlay issue.
EMR Duplicate Oversight Committee
Duplicate Processing Progress
• Duplicates Processing
– Number of potential duplicates within EMR
• March ’08 - 1.94% potential duplicates
• October ’08 - 1.04% potential duplicates
• January ’09 - 1.03% potential duplicates
• February to current - Daily potential duplicate creation
remain stable at approximately 90 per day
– Daily duplicate report maintained and resolved daily
Implemented Quarantine Overlay Process
Overlay flag placed No Patient is
Patient Arrives in HBOC, IDX or
on account at the Registered in
for Service Cerner for patient
enterprise level? respective system
Cerner Registration IDX Registration
message warning in
New CPI created
EMPI Team identify
Merge/quarantine Patient’s receiving Flag created on Email sent to defined
Process complete. New SID will be EMPI to prevent group identifying
Lock down EMPI. worked as ―A-List‖ return on patient data
for resolution quarantined CPI and new CPI
There will always be duplicates and
overlays created. A defined process
and management is the only answer!