UAGC Week 4 Managing Patient Identification as Master Data Paper

Review Scenario 15-B (pages 400 to 401) and the corresponding Ethical  Decision-Making Matrix (pages 412 to 413) in Chapter 15 of the course  text,

Ethical Health Informatics: Challenges and Opportunities

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Summarize the scenario, and express how you  would handle patient identity management in this situation. Support your strategy.

“Scenario 15-B Managing Patient Identification as Master Data
Compassionate Health Care (CHC) is an integrated delivery system affiliated with a state university in the
Midwest. CHC has grown from a single university teaching hospital to a network of eight acute care
hospitals serving the central part of the state. The medical faculty foundation has been merged with the
hospital corporation to become CHC. Independent physician practices have been acquired to form a
robust network of primary and specialty care services throughout the region. CHC’s mission includes
close partnering with community agencies so that promoting healthy communities is an area of special
emphasis.
Knitting such a large system together has required a concerted effort to unify the information
technology infrastructure from multiple stand-alone electronic health record systems to a unified IT
platform. Given the risks to patient safety, the difficulty of managing care transitions, and the cost of
maintaining heavily interfaced solutions, CHC’s leadership chose to replace disparate systems with a
single electronic health record system. This decision was made prior to the HITECH Act and the potential
for meaningful use incentive payments. At the time, it was a risky decision because of the cost and the
inevitable level of disruption. It was controversial because it would impose on physician practices joining
CHC a requirement to adopt a standard EHR solution and agree to a set of information governance and
management practices that were far more advanced than the homegrown approaches used by most
practices. After five years and investments of hundreds of millions of dollars, CHC has a unified
infrastructure managed by a corporate IT team. In this era of accountable care, the value of CHC’s vision
of a longitudinal, fully interoperable patient record is beginning to be more fully realized.
Elizabeth Vance, MBA, RHIA, was director of HIM for University Hospital at the beginning of this
transformation. She served on the IT strategic planning team and supported the vision of unified
technology for the growing system. To that end, she escalated the deployment of best practices at CHC’s
University Hospital so they could be adapted and adopted as new entities joined the growing system. An
early target for Elizabeth was to redouble focus on the policies and process for ensuring the accurate
identification of patients. Traditionally, the HIM manager was responsible for the master patient index
(MPI), but the function is now more commonly known as the identity management process.
Elizabeth understood that there are few information stewardship responsibilities that carry such obvious
risks of harm or such important benefits for accuracy. A patient that is not properly identified may be
given treatments contraindicated based on his or her present medical condition or medical history.
Inaccurate patient identification may convey precious health insurance benefits to the wrong person.
This may be intentional, as is the case in medical identity theft, or it may be unintentional. The cost of
correcting patient identification errors in electronic health records and across electronic claims
processing systems is significant. Elizabeth also understood that patient identification errors expose
protected health information to privacy breaches. Providers, patients, and their families may have
access to information that they would not otherwise be authorized to view. Individuals view proper
identification as a fundamental requirement of service, so errors in identifying a patient can also affect
the confidence of the patient in the organization.
In the past, duplicate paper medical records were fairly easily merged when it was discovered that a
second record had been created for a returning patient. Inadvertently merged paper medical records
could be separated when the identity of a new patient was mistaken for an existing patient. Elizabeth
understood that patient identification data is considered “master data” because identity management is
a linchpin of all digital and analog systems. If the identification is incorrect, the integrity of the entire
digital record is compromised.
Elizabeth approached redesign of the patient identity management system by taking an information lifecycle approach. She understood that improving the work done by HIM without engaging those who
were registering data or managing electronic patient matching for clinical data repositories, registries,
and other use functions would be inadequate. She communicated the importance of taking a holistic
approach and sought approval to set up a cross-functional team to examine the people, processes, data,
and technology from patient registration processes to long-term preservation of patient data. The initial
improvement project was carried out over several years through a multi-phased project that included:
Assessing the current state of information capture
Designing standard policies and processes
Organizing and staffing a data integrity unit
Upgrading technology to support processes
Training registration and data integrity staff and establishing performance metrics
Implementing ongoing performance monitoring
Formalizing ongoing governance mechanisms for continual improvement
Patient identity management remained challenging throughout CHC’s transition from multiple EHRs to
an enterprise platform. The lessons learned in improving the University Hospital systems were adapted
for each new organization joining CHC. Although today it is on a single platform, CHC continues its focus
on best practices although it has now reached a level of 99 percent accuracy for correct person
identification through training and vigilance.
Questions
What principles of fair information practice are advanced by effective patient identity management
practices? Data quality, because identity is critically important for the integrity of the health record;
security, because protecting identity is a risk that much of security practice is structured to guard
against.
Identify another critical “master data” identity management challenge that would benefit from a holistic
approach. Possible responses include: (a) Provider identification is a unique number assigned to
healthcare providers used by provider organizations and health plans. It is important to attribute care
accurately for payment, quality improvement, and other purposes. (b) ICD codes are reference data
used to classify or categorize diagnosis and procedure data. Other types of reference data, such as
SNOMED and LOINC codes, are also considered master data.