An Introduction to

Effective MPI Management

Purpose, Components, Benefits and Implementation

White Paper
Robin Altendorf, MA, RHIA

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 White Paper

An Introduction to Effective MPI Management

Purpose, Components, Benefits and Implementation

An accurate Master Patient – or Person – Index is arguably the most fundamental

and important resource in a healthcare provider organization. The MPI, also
known as an Enterprise Master Patient Index (EMPI), contains critical information
necessary for the prompt location of every patient’s complete and accurate
medical record. It is the link to track patient activity across care settings in an
enterprise or health information exchange.

Many healthcare organizations have MPI databases in one or more systems

operating independently within a single facility, multiple facilities, or at
satellite locations in remote areas. Such databases may also be focused on
a particular departmental operation, or shared across multiple departments
or other functional areas. Managing and maintaining data integrity in these
disparate systems is a health information management challenge that requires
coordination of people, processes, and technology.

This paper will provide readers with the following information:

• A detailed review of the Master Patient Index
• The definition of an Identity Management Program
• Implementation and benefits of an Identity Management Program
• How QuadraMed’s Smart Identity Management software and services can help

Unfortunately, MPIs are often compromised when patients are inadvertently

added to a system multiple times or when data are entered incorrectly. Such
errors hinder patient care because they create an environment in which
clinicians cannot access the complete health history of their patients.

To put this problem in proper perspective, the industry-average MPI error rate
is 10 percent, yet it is generally accepted that a low percentage of hospitals
nationwide have performed a MPI cleanup and implemented a long-term
quality program that includes a MPI monitoring system. Only recently has the
concept of a MPI Identity Management Program gained recognition as a critical
component of both patient safety and the financial viability of healthcare provider
organizations.

Implementing such a program is among the least expensive process and technology
investments made by hospitals, and offers a fast, measurable return on investment.
In brief, MPI data integrity programs:
• Increase internal operating efficiencies
• Protect the integrity of electronic medical records
• Support initiatives to minimize potential adverse events for patients
• Improve customer service
• Improve clinical and financial outcomes
• Serve as a foundation for the Red Flags Rule Program

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To assist healthcare organizations with ongoing MPI Maintenance and establishment

of an Identity Management Program, QuadraMed’s Smart Identity Management
Solutions suite of software offers several tools that may be purchased alone or in
conjunction with Identity Management services. These tools are further described later
in this paper and include: SmartScan, MPIspy or Smart Identity eXchange (Smart
I/X), SmartMerge, SmartManager, SmartID, SmartSwipe, and Identity Management
Professional Services.

Background
Traditionally, the MPI was maintained manually in bound volumes, or more likely in a
card file, by preparing an entry for each patient admitted to or treated at a healthcare
facility. Since the early 1980s, automating the MPI has been the accepted practice
to facilitate tracking of patient information in hospitals. Today, automated EMPIs
are common in integrated delivery networks (IDN) and many health information
exchanges (HIE) rely on a Record Locator Service, which is basically a regional
EMPI, to facilitate the sharing of information among participants.

Electronic record storage of MPI data is a significant improvement over a manual

process. Each department within a hospital or participating facility within an IDN or HIE
may quickly and simultaneously access the MPI to register new patients, edit patient
information, and locate patient records. Data control is normally a joint responsibility
of the Registration and Health Information Management (HIM) departments, with IT
usually providing the technological foundation.

The Importance of an Accurate MPI

The electronic MPI is a central repository used to locate and link patient information
needed to support the delivery of care. Most hospital information system software
includes MPI and registration functionality that simplifies searches for existing records
and prompts registration staff to enter correct and complete patient identification data
when a Medical Record Number (MRN) is assigned to create a new medical record.
Unfortunately, most hospital information system (HIS) software does not incorporate
advanced record matching tools to prevent or report duplicates, nor does it provide
any support for managing and correcting MPI data integrity problems. QuadraMed
identity management software enhances the performance of the HIS by integrating
a probabilistic record matching algorithm into the search and selection pathways,
and by providing workflow tools to manage reporting and remediation of duplicate,
overlapping, and overlaid records in the EMPI.

When using an accurate, well-maintained MPI, a patient’s complete history of previous

encounters can be viewed in the MPI database. Other critical health information such as
allergies, medication lists, or chronic disease information may also be stored in the MPI,
or may be accessed in the electronic medical record system after the patient is properly
identified and selected. This facilitates treatment by giving all care providers reliable
access to the patient’s health information.

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When the MPI has poor data quality and integrity, failures in patient search and
selection may occur. Such failures result in the creation of a new patient MRN, which
generates a new and separate medical record, thereby fostering an environment
in which the patient’s medical information is in disparate medical records. Billing
problems, unnecessary duplication of tests, and increased legal exposure from adverse
outcomes can often be attributed to a failure to locate existing patient information.

A centralized and accurate patient index, utilizing probabilistic matching tools, offers
numerous benefits. It brings disparate records together in a database that is easily
accessed by multiple users simultaneously. Maintenance efforts are more easily
managed and coordinated when the appropriate workflow and reporting tools are
available. Advanced MPI systems use patient core data elements in the repository to:
• Accurately match persons being registered with their existing correct
medical record
• Minimize creation of duplicate records across the enterprise
• Link multiple MPIs to create an EMPI or Record Locator Service
• Facilitate the linkage of patient records within and across facilities to support
exchange of clinical information
• Enable creation of a comprehensive Electronic Medical Record (EMR)

MPI Integrity Problems

MPI integrity continues to be an insidious complication of inadequately designed
software applications used to manage patient information. Locating the most accurate
version of a patient’s medical record and updating it quickly can be problematic in some
systems. Merging duplicate medical records within a facility, much less merging MPIs
across multiple sites, generally continues to be a challenging task for healthcare staff.

Variations That Undermine MPI Integrity:

There are two categories of variation in medical records that undermine MPI integrity:
1. Patient identification errors leading to fragmented information
2. Distinct data variation when generating MRNs

Patient identity errors are defined by the following types of patient medical records
in the MPI:
• Duplicate – the patient is assigned two or more MRNs within a single
MPI database
• Overlay – the patient is assigned another patient’s MRN
• Overlap – the patient has two or more MRNs in different source
MPI databases contributing to an EMPI.

Patient identification errors primarily occur due to:

• Changes in identifying attributes such as name, address or
telephone number
• Typos, transpositions or misspellings
• Incomplete capture of core data elements
• Limited search technology in the registration system
• Careless selection of the wrong record or overlooking the existing record

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The second category consists of distinct data variation when collecting patient data
and assigning identifiers. This occurs when the patient visits multiple different facilities
within the IDN or HIE, or when the patient is seen in different ancillary departments
within the same facility, and each facility or department utilizes different processes for
patient registration. Lack of data standards contributes to variation in data entry, which
frequently results in assignment of new identifiers. The only way to link the patient’s
multiple numbers is to rely on comparing patient demographic data. Because patient
attributes may differ due to patient identification errors or failure to follow data entry
standards, the enterprise linking process can be compromised.

Regardless of the error type, the integrity of the medical record suffers. The quality
of patient care also may suffer because the newly assigned medical record number
serves only as a means of coordinating and aggregating information for the current
encounter. Such errors disconnect patients from their previous history.

Preventing errors depends in large part on staff members who process the registration
and admission of patients. During the hiring process, pre-employment exams can
be used to test the aptitude and competency of candidates to become registrars.
Process improvements and technology can also be leveraged to prevent errors.
Establishing data entry guidelines, defining accuracy standards, monitoring quality,
and implementing staff training programs all positively impact data integrity.
Implementing advanced matching and remediation software tools brings the
benefits of technology to support the human processes of registration.

A Compendium of Consequences
When a patient is registered, the assigned MRN becomes a proxy for identity.
Breakdowns in the identification process and MRN errors can create the
following issues:
• Customer service suffers as repeat patients are treated as new
• Credibility drops when patients question the organization’s management of their
medical records
• Physicians are frustrated due to the risk of providing treatment based upon
incomplete or inaccurate records
• ROI is not realized for the electronic medical record and other technology
investments
• Clinical risk increases due to incomplete patient care information
• Revenue Cycle Management initiatives to improve cash flow are impaired by the
inability to reliably link all accounts for a patient or guarantor
• Inability to accurately measure member activity across facilities or service lines
weakens negotiations with health plans and insurance companies
• Planning and marketing efforts are hindered by the inability to define and
understand physician referral patterns and patient activity across multiple service
lines or facilities
• Regulatory risk increases due to inconsistent management of patient information
according to HIPAA and other legislative requirements
• Operational inefficiencies surface from the ripple effect created by MRN errors as
they spread across departments.

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The MPI Integrity Solution

Addressing MPI data integrity requires focus on business processes and technology.
A total solution consists of three phases: Assessment, Intervention, and Monitoring/
Maintenance. QuadraMed Smart Identity Management Solutions are an example of
this multi-phased approach to MPI Integrity. The solutions are further optimized by an
Identity Management Program to address continuous monitoring and improvement.

Assessment
Assessment is the first step, and includes an evaluation of the MPI data and a
review of the organization’s MPI issues and processes. The goal of the assessment
is to determine:
• Volume of duplicate/multiple records
• How patient admission and registration data is collected
• How data is entered in the MPI
• Types of errors occurring within the MPI

Top tier vendors like QuadraMed generally use a proprietary probabilistic algorithm to
analyze MPI data using complex mathematical principles to identify and categorize
errors. QuadraMed’s data analysis service is called SmartScan. The SmartScan
is performed to determine the volume of duplicate/multiple records and the types
of errors occurring within the MPI. SmartScan uses the proprietary SmartPAL
Probabilistic Matching Algorithm, which has a 98 percent accuracy rate, and minimizes
both false positives and false negatives. Through this statistical evaluation of the MPI,
detailed reports are generated, providing relevant information regarding the data
integrity errors.

A Project Scoping Interview is typically scheduled via conference call with appropriate
stakeholders and departmental representatives, i.e. HIM, Registration, IT, Laboratory
and Radiology. The organization’s processes are reviewed, the impact of MPI errors
is assessed, and the extent of the duplicate problem is discussed. Goals for process
improvement and data quality are established, and constraints are documented. A
subsequent proposal and estimated quote for a customized MPI solution is produced
at the conclusion of the Assessment.

Intervention
A “clean-up” of the MPI is often required to eliminate duplicate medical records,
overlays and overlaps. This can be a complicated, labor-intensive process touching
many electronic systems and physical records. It is seldom cost-effective when
conducted with existing in-house staff. Once organizations recognize the work
required to effectively correct past MPI errors, they may opt to engage with a vendor
to conduct the MPI Cleanup project.

When the errors have been identified by SmartScan and reported, potential matches
are verified to determine that the duplicate records actually represent the same
individual. Determinations must be made regarding record and data survivorship,
merging and linking within and across domains of data. This process often relies
upon a combination of automated business rules and human review to obtain the
best results.

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Electronic merges may be performed in multiple systems, including the hospital

information system, and various departmental systems such as Radiology or
Laboratory. Physical paper records (charts) or Radiology film jackets may also be
merged. The process of merging and linking records requires knowledge of and
adherence to data governance and data stewardship principles, particularly in the
IDN and HIE environments.

Project Management is necessary to coordinate the various people and processes

required for a successful remediation project. QuadraMed provides full outsourcing
of MPI Cleanup projects, and provides management and administrative resources
to design and deliver accurate, cost-effective record merging. Projects begin with a
detailed two to three week Project Design, where all variables are documented, time
studies are performed, resource requirements are determined, and a Project Charter
is produced to document the project scope. After client approval of the Charter, the
QuadraMed project team performs the MPI Cleanup. During this process, regular
monitoring and reporting is provided to track performance against plan.

Technology is used throughout the project to automate processes. SmartMerge and

SmartManager are tools that help resolve duplicates. SmartMerge is a workflow
tool used to review potential duplicates and mark them for merging in the MPI.
SmartManager executes specific steps to complete the merge process electronically
for duplicate sets that have been confirmed to represent the same person.
Customized business rules can also be leveraged to automate manual processes
of record linkage.

Monitoring/Maintenance
The increased use of electronic records and the formation of IDNs and HIEs require
greater emphasis on a continuously clean electronic MPI that incorporates those
capabilities already discussed, and additional functionality such as:
• Flexibility to incorporate patient numbers from the legacy systems of providers
added to the organization
• Ability to accommodate network changes or changes in identification parameters
• Easy configuration without requiring extensive programming
• Scalability and designed for long-term growth

From an enterprise perspective, an enterprise-level unique identifier will be required

for each patient to link the patient’s episodic information. Standardized MPI software
that contains information to uniquely identify a patient and point to where all segments
of that patient’s records are located facilitates the process of accessing information
across the continuum of care.

QuadraMed technology is a key component of ongoing MPI maintenance initiatives.

SmartID and SmartSwipe are registration and scheduling tools that improve the
accuracy of patient search and selection, thereby reducing the creation of new
duplicates. The indexing engines, MPIspy or Smart I/X, utilize the SmartPAL algorithm
for ongoing detection and reporting of MPI errors, enabling staff to correct errors and
adjust processes for optimal MPI accuracy.

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The Identity Management Program

As healthcare technology evolves to form more integrated systems, MPI integrity
becomes increasingly important because there must be an exchange of information. An
ongoing Identity Management Program, tailored to the unique needs of the organization,
brings together people, processes and policies to ensure long-term success.

Mentor Assess

Maintain MPI
Improvement-Focused
Model
Educate

Monitor Review
The Improvement Focused Model (IFM) is useful to determine what actions are necessary to
develop an optimized Identity Management Program tailored to the organization’s needs. The
IFM also can prove to be an important guide for selecting a vendor partner. A model of continuous
improvement in solution design and implementation achieves the best results.

MPI assessment is the first step, and includes an evaluation of the MPI data and a
review of the organization’s MPI issues and processes. After the initial assessment and
intervention, the focus shifts to maintaining the improvements using the Improvement
Focused Model.

The next task in the model is to educate staff and departments regarding the
importance of the MPI, how MPI data is gathered and used, and key processes for MPI
maintenance. During and after the MPI Cleanup, quality initiatives will not be effective
if the staff is not qualified or trained to perform their duties. Assessing the MPI and
educating staff through internal training, monitoring and error resolution are necessary
to determine the needs of an Identity Management Program.

The third task is to review the most current policies and procedures for the MPI.
Following this review, the goal is to modify business processes to support MPI data
quality and integrity. Areas of focus for process review include:
• Data element policies and conventions adopted for use in the MPI
• Registration procedures for patients
• Procedures for communicating with ancillary departments
• Training procedures and processes for current registration staff and all new hires
• Identification of the contact person for changes, edits, and revising forms, policies
or procedures

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MPI data must be reliable and consistent; therefore, the program must include
Smart Identity Management Solutions
monitoring:
• Issues addressed by the quality improvement committee The Smart Identity Management product suite
• Compliance with the organization’s data quality management policies comprises powerful, effective tools to identify, correct
and procedures and prevent the creation of duplicate patient records—
tools that scale to the size and complexity of the job.
• Regular reviews and steps to address shortcomings identified through continuous
Advanced probabilistic person-matching capabilities,
quality improvement activities
modular software products, and comprehensive
consulting services ensure accurate patient identification
To achieve the best outcome, powerful and flexible reporting tools are essential.
within the hospital, enterprise, integrated delivery
Problematic steps in the process need to be identified by individuals or teams who
network (IDN) or health information exchange (HIE).
then make recommendations for change. Therefore, the organization must maintain:
Powered by SmartPAL, QuadraMed’s Smart Identity
• Communication between the quality improvement team and the committee Management Solutions give hospitals and IDNs:
• Documentation of the accuracy of the MPI by the HIM and Registration • Improved information accuracy: Resolving Identity
departments Management errors mitigates uncertainty among
• Consistent compliance with established guidelines physicians and facility personnel that often result from
duplicate or fragmented records. Complete patient
The last task in the model is mentoring to: histories support clinical care, facility operations and
business management.
• Encourage open expression
•S
 trengthened risk management: Immediate
• Explain the Identity Management Program in detail to all new employees and identification and resolution of errors helps reduce
associates their financial and clinical consequences and
• Develop effective communication, presentation, and teaching skills precludes inappropriate disclosure of confidential
patient information.
• Conduct monthly quality reviews and provide feedback
•E
 nhanced customer service: Complete,
An Identity Management Program, based on this model, is proven to provide the consolidated patient information under a single
tools to effectively manage all of the components that ensure MPI integrity across identifier streamlines patient access and eliminates
the enterprise. service delays to provide a better overall customer
experience.
• Increased productivity: “Missing” but previously
Conclusion
collected information can lead to unnecessary testing,
Quality patient care is dependent upon an understanding of current and past medical
redundant efforts and delays in receivables because
conditions. If patient identification information in the MPI is compromised, patient of unresolved patient identity errors. Smart Identity
data become fragmented, and there is patient safety risk directly associated with Management solutions resolve the errors, enhancing
incomplete information. This underscores the importance to develop and implement efficiency, workflow and staff productivity.
an Identity Management Program.
•T
 ightened compliance: Smart Identity Management
Solutions improve compliance with state and federal
The ultimate goal of every Identity Management Program is to help patients return regulations, including The Red Flags Rule and
to healthier, more productive lives without risk of clinical and/or financial mistakes HIPAA requirements. The solutions help healthcare
resulting from MPI errors. Such programs have demonstrated improvements in organizations establish systems and processes
patient safety and quality of care at the front end of the process, while also improving to prevent identification errors before negative
financial outcomes for providers at its conclusion. consequences occur.

QuadraMed Smart Identity Management Solutions include a comprehensive suite

of proven products and services that enable efficient and cost-effective Identity For more information about QuadraMed
and our solutions, visit our website at www.quadramed.com
Management across the spectrum of healthcare providers. From complex regional
systems, IDNs and large multi-facility organizations to community hospitals,
toll free 800-393-0278 • main 703-709-2300
QuadraMed is the leading provider of MPI Cleanup services and leading-edge
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technology to accurately identify patients; administer and reconcile patient records;
protect patient data integrity; and manage patient access and resources.

©2010 QuadraMed Corporation. All Rights Reserved. QuadraMed, MPIspy, Smart I/X, SmartScan, SmartMerge,
SmartManager, SmartID, SmartSwipe and SmartPAL are registered trademarks, and QuadraMed Smart Identity Management
Solutions is a trademark of QuadraMed Corporation. 122009tc