Registration accuracy driving factor for Baylor's newly implemented EMPI
Registration accuracy driving factor for Baylor's newly implemented EMPI
'It greatly enhances our ability to identify the right patient'
Baylor Health Care has implemented an enterprise master patient index (EMPI) that will allow patients at a dozen hospitals scattered over four counties to be registered more easily and with greater assurance of accurate identification.
"One of the driving factors with the EMPI was to become more patient centered in relationship to knowing who our patients are," says Mary Best, corporate director of access services for the Dallas-based system. "We have patients who have been in the Baylor system for many years — at one or multiple facilities — but if they go to a different [Baylor] facility at this point it's like they've never been [in the system] before."
Baylor also is moving toward implementation of a single admission/discharge/transfer (ADT) system, she says, with the first hospital scheduled to go live in July 2007. The full roll-out will take roughly three years, Best adds.
At present there are seven different registration systems among the 12 hospitals, she notes, and none of them are interconnected. "Four are on the same system, but are totally partitioned.
"We want to be more sensitive to patient needs, more focused on service to them," Best says. "We want to have a warehouse of data that will enable us to identify that patient anywhere within the system."
Another driving factor with the EMPI is patient safety, she says. The ultimate goal is to have an electronic medical record (EMR) that will be available to patients' physicians and to other facilities, Best adds. "When the patient presents, [registrars] would not only identify the patient, but have access to the patient's EMR."
The EMPI in place at Baylor "has a very powerful set of algorithms," she notes. "It greatly enhances our ability to identify the right patient and so reduces the possibility of misidentification."
The idea, Best explains, is to prevent two kinds of mistakes from occurring when, for example, a Baylor patient named Jane Smith presents. One error would be pulling up the wrong Jane Smith, who might have a different blood type. The other would be failing to identify the person as a Baylor patient and so not gaining access to her existing medical record.
The algorithms of the Baylor enterprise system are aggressive enough to "narrow down the field," even with a common name, thereby minimizing the possibility of creating an overlay on the same record, she says. "You can select [parameters] to be as restrictive as you want. You can say it has to match seven of these key data elements or you can broaden that range, or you can have more options from the individual to select from."
At present, the Baylor EMPI is in "passive mode," Best says. "It is not hooked into the registration system and we are not using it for patient identification yet. We have activated and brought up each of the hospitals on the EMPI and each of those is feeding data into it. They are updating the EMPI, whether on existing patients or with new data that are flowing in."
Behind the scenes are the programs it actually will run to identify post-registration duplications, she says. The challenge, and something the Baylor team "worked on quite rigorously," Best explains, is to identify the most complex algorithm that would minimize duplication or misidentification "without creating a nightmare in which everything is going to come up" to be looked at by the registrar.
Typically, there is a hierarchy of data items that will be weighted according to their importance in the process, she says. Patient name and social security number, for example, have greater weight than spouse's name. "The number of data items that have a potential match helps drive the determination as to whether this record is one that might be a duplicate."
Since Baylor is in passive mode with the EMPI for the time being, she notes, "the damage is already done. The patient is already registered and has already received care, but it will notify us of potential duplicates and potential linkages."
Avoidable vs. unavoidable duplications
In the case of potential duplicates, Best says, the account is reviewed and evaluated by access services staff to see if the occurrence was "avoidable" or "unavoidable."
"'Unavoidable' might be someone who comes in comatose, who was picked up on the street with no ID," she says. "There is nothing we could have done to have identified the person correctly."
What access employees focus on are the cases that could have been avoided, Best notes. "It helps to determine what we did wrong, and what we can do to prevent that.
"There are a variety of things to look at," she adds. "A good example would be where someone transposes a number in the Social or didn't enter the birth date correctly. Sometimes there is a handoff from someone who gives the incorrect spelling on a name. We still consider those avoidable because we need to move further upstream to make sure the name is entered correctly."
One of the things Baylor did as a lead-in to the EMPI project, Best says, was to establish a standardized name-entry policy. "There had been a nebulous policy on how to define the patient's legal name and how to validate it, but we decided to move away from that. We wanted the name to be something we could verify." (See related story in box.)
Name-entry policy tightened as lead-in to Baylor EMPI 'Step-down process' outlined One of the things Baylor Health Care did in preparation for its enterprise master patient index (EMPI) implementation was to establish a standardized name-entry policy, says Mary Best, corporate director of access services for the Dallas-based health system. Moving away from a "nebulous" policy on how to define and validate a patient's legal name, she adds, the organization decided to go with something that could be verified in a concrete way at the point of service. "We want a state-issued picture ID so registrars can look at the individual and see that it is the right person," Best says, "and are able to confirm, for example, that the first name is Harriet, and the middle name is Jane, and then register the person under that name." The form of identification might be a current and valid state-issued driver's license or other state or federal-issued ID card, she says. A card issued by the U.S. Citizen & Immigration Services, a state-issued ID card or a passport ID form can be used, but must include a picture, Best adds. (See Baylor's policy.) Otherwise, if one Baylor facility registered the patient as Harriet Smith, another registered her as H.J. Smith, and a third registered her under a nickname provided by a friend or family member, "that could lead to misidentification," she says. The new Baylor policy defines a "step-down process," outlining the steps to be taken when the required form of identification cannot be obtained, Best says. "Ideally, if a patient comes in as John Doe, when he is identified, the [staff] will correct the registration and look for a picture ID." Both picture ID and insurance cards are scanned as part of the medical record, enabling validation that the individual presenting is correctly identified, she says. "Through the standard naming convention implemented two years ago, ongoing variation in name entry is minimized, reducing the potential for duplication or misidentification in the future. "In the past," Best adds, "there were concerns about insurance denials or returns if the patient name did not match the name as reflected on the insurance card." That is no longer an issue, she notes, because each registration system now in use enables registrars to enter a patient name, a guarantor name, and an insurance name. "Under HIPAA electronic billing guidelines, the patient name will be changed to the insured name if the relationship code is 'self,' ensuring the payer's ability to identify the patient without delay," Best explains. Through the use of the EMPI and the advanced algorithms, long-term patients registered under different names — Bob, Bobby, Robert, for example — are identified and linked both within the same hospital and across hospitals within the health care system, using an enterprise-level MPI number, she says. "If the patient has been assigned more than one medical record number within the same hospital, the records are merged under one medical record number," Best says. "Since there are multiple registration systems in use at Baylor and each hospital has historically used its own numbering schema, these records are not merged but are linked through the enterprise MPI number." |
As Baylor moves forward with the implementation of a single ADT system, Best says, it concurrently will be implementing the active mode of the EMPI.
"That will give access services the opportunity to take advantage of the aggressive algorithms," she adds. "[The system] will come back and give access services the list of potential individuals to avoid that duplication from the beginning, [resulting in] truly improved patient identification and safety."
"We still have work and planning to do, and there are decisions that will need to be made as we start the roll-out process," Best says. "If it is determined that the patient has two medical records, access won't be in a position to merge those two. We will have to have a protocol for which record they choose for the new visit. Some prep work will be needed."
Physician participation in EMPI
One of Baylor's current initiatives is to go ahead and update the master patient index with data from its provider-owned physician practices, she says. "These will be primary care physicians for the most part, so they will have a broad population of patients. Typically, but not always, these patients would go to Baylor for inpatient care."
Pulling in that physician practice information, Best notes, further assures that as people select one of these physicians for primary care, should they need inpatient or outpatient service at Baylor, "we would already have their information, even if they've never been to our hospitals."
In addition to improving customer service, she points out, this will further the ability to feed information into the electronic medical record that is accessible to physician and hospital.
Future plans involve including some of the larger physician groups that practice predominantly with Baylor, Best notes. "As we move forward, if we can work through the electronic upload details, we will begin building their data into our MPI as well.
"One of the things we've heard from patients is, 'Why is it that every time I come I have to go through an extensive registration process?'" she adds. "This is the beginning of minimizing that."
"We will still have to see if there is missing data, and perform the regulatory requirements, but ideally, if you walk in for the first time and the physician is providing uploaded information, at least we will know who you are."
(Editor's note: Mary Best may be reached at [email protected].)
Baylor Health Care has implemented an enterprise master patient index (EMPI) that will allow patients at a dozen hospitals scattered over four counties to be registered more easily and with greater assurance of accurate identification.Subscribe Now for Access
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