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The Impact of Duplicate Medical Records and Overlays on the Healthcare Industry with Beth Just, President and CEO of Just Associates
Podcast length – 52:39

Topics Covered in Podcast:
What are overlays and how are they different from duplicate medical records? What are the implications of overlays and duplicate medical records and why do they pose a threat to patient safety? What is the actual % of duplicates and overlays at medical facilities vs. what industry experts say and why is there a discrepancy? What impact to overlays and duplicates have on a medical facility’s revenue stream and billing cycle? What are the potential implications of duplicates and overlays on healthcare data integrity and the ability to raise the quality of care and lower costs?

Topics Covered in Podcast (continued):
How much time and resources are needed to correct duplicates and overlays? What additional steps are needed for prevention? What technologies today are predominantly used to eliminate duplicates and overlays and what others are viable solutions? What priority do hospitals place on addressing the issue of duplicates and overlays?

What are Overlays vs. Duplicates and what are their Implications?
• Overlays occur when two different patient records end up in one medical record as opposed to duplicate records which occur when a patient is assigned more than one medical record number

Implications:
• Duplicates – patients are treated with missing information – could be dangerous (e.g. – incorrect blood types, severe allergies) • Previous tests can be missed – physician has incomplete information • Tests can be repeated – most common example was chest X-ray – this raises the cost of care and can be particularly dangerous (e.g. – unnecessary exposure to radiation in children) • Potential to have large financial impact on ACOs • Decreases available staff and resources to treat other patients • Delay in treatments

What are Overlays vs. Duplicates and what are their Implications? (continued)
• Overlays • Cause a huge patient safety risk – treating one patient with another person’s record • Quality of care problems created are numerous and extremely dangerous

Did you know?

It can take over 100 hours to fix one electronic record overlay!

Why are Overlays and Duplicates Particularly Troublesome for Children’s Hospitals?
• Higher risk for duplicates and overlays to be created at pediatric hospitals • Children can’t speak for themselves • Care giver may not know accurate demographic data of child (e.g. – DOB), child has no formal mode of identification • Can lead to adverse medications and duplicate diagnostic tests

Did you know? Incorrect dates of birth are 10% more likely to occur on pediatric records than on adult records.

Reconciling Duplicate/Overlay Estimates with Real World Results
• • • Many industry resources (e.g. AHIMA) say hospitals average a 8% - 12% duplicate medical record rate Rise of IDNs is exponentially increasing size of EMPIs and data indexes from disparate sources causing more overlays and duplicates The actual duplicate and overlay rate depends a lot on how duplicates and overlays are measured, based on the strength of underlying identity algorithms – standard hospital information system versions are typically not strong – hospitals tend to know about just 20 – 30% of all duplicates that truly exist Industry researchers tend to rely on more sophisticated, error tolerant identity algorithms and provide more accurate measurement

Impact of Duplicates/Overlays on Revenue
Fee for Service:
• • • Revenue impact centered on delays in issuing the bill due to problems with demographic patient data integrity Inability to combine bills for visits occurring within 72 hours risking charges of fraud from Medicare/Medicaid Inability to identify patients who owe, or may have bad debt

ACO Model:
• Larger impact and higher risk to providers and groups • Can’t longitudinally trend data for one patient to assess care received and determine proper course of subsequent care • Can’t accurately assess quality and effectiveness of services provided • Inaccurate views of specific provider quality and efficiency

Impact of Duplicates/Overlays on HIEs
*Typically, the larger the data set, the more duplicates and overlays that exist • • • Very few HIEs across the country have staff dedicated to measuring the quality of data coming into the system including the patient identity Many HIEs lack data governance policies and those that do have little power to enforce them Data tools used to collect, store, and disseminate information across HIE don’t have strong record matching algorithms – creates problems of overlap with patients going to different hospitals and providers Often times duplicates aren’t noticed until a provider starts searching and pulling data from across the network Overlays may be detected by providers but if not, significant patient safety risks may occur Many HIEs have greater than a 30% crossover (overlap) duplicate rate Overlays and duplicates diminish the ability of HIEs to raise the quality of care – it decreases their value and the incentives for providers to join


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Amount of Time Needed to Correct Overlays & Additional Steps Beyond Clean-Up
Duplicates:
• Easier to fix because most patient data software have utilities to allow staff to merge and/or correct records

Overlays:
• Time to fix can range from an hour to months depending on complexity • Depends on EHR system and how easy it is to peel a record apart • The time the overlay has existed also affects how easy it is to correct • The number of providers touched by overlays also makes them complicated to correct • Staff must comb through note by note and result by result to correct record
Beyond correcting the overlay or duplicate, staff must be retrained and an auditing system created to establish accountability

Technologies to Eliminate Duplicates and Overlays
• Record searching algorithms in patient scheduling and registration systems • More powerful the algorithm, less likely dups and overlays will be created • Success of algorithm dependent on staff training, successful understanding of how search functions operate, and how to effectively evaluate & validate results Biometrics for patient identification are increasingly used for accurate patient ID • Streamlines registration • Significantly increases patient ID accuracy • Faster healthcare adopts, faster ROI will be realized Studies show that regularly scheduled feedback to patient access staff with examples of correct and incorrect patient data entries drastically reduces the creation of duplicates and overlays

Hospital Priority on Fixing Duplicates and Overlays
• • • • Greater awareness of duplicate problem at Executive and C-level that the problem even exists Heightened activity in conducting master patient index (MPI) cleanups of duplicates Some EHR/EMR vendors mandate that medical facilities installing their software report duplicate thresholds before they can go live with deployment Meaningful Use requirements have indirectly spawned more attention and action to reduce duplicates and overlays Less attention at C-level for overlays, often times not recognized until an adverse event happens Since most overlay discovery is anecdotal, it’s unknown how often it truly occurs - there often isn’t the technology or processes in place to catch overlays Hospitals will start to demand more services and technology that report patient ID inaccuracies


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The Value of Establishing a National Patient Identifier (NPI)
• • • • • As healthcare databases increase in size, the chances of duplicates and overlays increases exponentially Increased national attention on the importance of accurate patient identification will bolster the call for an NPI In the absence of an NPI it will be very hard and not cost effective to perform the level of data exchange created by EHRs and have patients take ownership and control of their own care NPI won’t solve the entire problem – there will always be theft, inadequate registration training, human error, and historical data errors in the master patient index (MPI) Despite having one, patients may not always remember to bring NPI when they seek healthcare

Thank you to Beth Just for her time and knowledge for this podcast!

Contact Information
John Trader PR and Marketing Manager M2SYS Technology 1050 Crown Pointe Pkwy. Suite 850 Atlanta, GA 30338 jtrader@m2sys.com 770-821-1734 www.m2sys.com : twitter.com/m2sys : facebook.com/m2sys : linkedin.com/company/m2sys-technology

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