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					 The Art of Mastering
 Patient Identification

Stephanie Middleton, Product Manager
       Information Technology
         Sentara Healthcare
            April 15, 2010
                                      About Us
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
North Carolina.

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.
                   Our Vision
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
    registration function.

          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!
           EMPI Terminology

• 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 Discovered

• 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
  timely manner.
• EMPI not detecting overlays due to not enough information being
  changed at one time (i.e. only name was changed, and no other
  demographic information).
                What is an Overlay
Two or more different people share the same patient
identifier (EMR, SID, CPI).

Jamie Lewis
EMR: 456798045
Birth Date: 1-13-1978
MRN: 233005678
SSN: 233005678
Address: 204 Hollow Point Dr.      STOP!
Virginia Beach, Virginia 23452   Same EMR #
James Lewis
EMR: 456798045
Birth Date: 1-13-1978
MRN: 456798048
Address: 204 Hollow Point Dr.
Virginia Beach, Virginia 23452
                       Root Causes
• 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
                                                             Resolution Time

                                             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
       Patient Charts
             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

                             Registrar searches
                                                            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
                                  to register


                                                                                      HBOC System
                                                                                     Registrar receives
                                 Cerner Registration          IDX Registration
                                                                                      potential overlay
                                      System                      System
                                                                                     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
                        Determine merge
                                                     for resolution               quarantined CPI              and new CPI
                          or quarantine
  Biggest Challenge

         In Conclusion

There will always be duplicates and
overlays created. A defined process
and management is the only answer!
Questions ?

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