Eight healthcare organizations in the Twin Cities area were contacted regarding participation in the study. Out of those who were contacted, 7 completed the survey, 6 electronically via email and one by interview. Three of the responding organizations represented single hospitals, and the remaining 4 responses were from systems ranging from 2 to eleven hospitals. The smallest hospital responding has approximately 300 staffed beds, and the largest responder has approximately 2,500. The average number of staffed beds was 982 with a median of 581. The majority of the responses came from public, non-profit organizations.
provides the summary results. All of the organizations who responded (n=7) have begun to seriously address the issue of duplicate records (). One of the healthcare organizations began addressing the issue in 1994, while others did not begin their investigations until after the year 2000. Several of these organizations noted that they have increased efforts after the implementation of their EHR, or after massive MPI cleanup efforts.
Summary results of quantitative questions.
Out of the seven surveys received, only two had identified an acceptable level of duplicate records (). Among those who had not identified an acceptable level of duplicates, one noted that they are in the process of determining this level and another stated that “any duplicate is one too many.” The first organization who identified as having established an acceptable level of duplicates reported it as being 1.85% in the entire MPI, with a daily creation rate of 5.5%. They also report that these are promptly addressed within 1 to 5 days. The other organization reports their acceptable level to be 0.02%.
Five of the seven responders stated that the EHR has changed their perception of duplicates (). Of those who responded in the affirmative, three noted that it has made duplicates easier to find. Another response was that the EHR has made the problem of duplicates more complex. The remaining organization noted that they have realized that a duplicate is better than a comingled record where two patients have been erroneously merged together.
Almost half of the organizations have named a specific committee that is responsible for duplicate record oversight (). They listed the names of the committees as the Data Integrity Steering Committee, Data Systems Workgroup, and Performance Management and Improvement. The other four stated that they do not have a specific committee, but instead used a cooperative effort of their IT and registration staff when needed.
Six of the organizations try to reduce duplicate record creation recurrence by providing feedback to the employees/supervisor after identifying the source of the duplicate creation. Out of the six who provide feedback, only one mentioned that they provide additional training. The remaining hospitals stated that they identify the source, and investigate patterns in duplicate creation in order to implement a solution, but do not specifically mention training or feedback as part of that solution. When asked directly whether or not they have trained their staff on the prevention of duplicates, six responded yes, while one said no but is intending to do so ().
When asked whether or not the organization had successfully migrated from paper to electronic records two responded “yes”, and the other five are “in process.” When asked what impact the migration had on duplicate records, two responded that it increased them while one reported that there was neither an increase nor decrease. Two responded they had to do a large clean-up of their MPI and EHR. Another organization stated that the migration has made duplicates easier to identify. The final respondent stated that since the providers are now searching for records as opposed to HIM staff, it makes it more likely they will be unable to locate correct records.
The next question related to the perceived impact of duplicate records on the EHR and patient safety. Six of the survey responders mention that there is a potential for providers to miss important patient information. One stated that it made it more difficult to prevent unwanted patient outcomes. Others mention that there is also potential for duplicate orders and billing, erroneous documentation, and patient frustration. One participant admitted that patient safety events have occurred due to duplicate records created in the Emergency Department when unresponsive patients have been issued a new MRN. Despite the excellent example, they did acknowledge that this problem also existed when they were on a paper system. Additionally, it is also noted on one survey that duplicates complicate patient look-up by adding more records for the end-user to choose from and decrease the validity of reports run from the EHR
There is some discrepancy in the way that duplicate medical records are counted in the Twin Cities area. While all 7 healthcare facilities report counting a duplicate record pair as one, only two consider multiple duplicates to be one. Three other organizations count them separately, and two either have not found this or report it is a rare occurrence.
The majority of hospitals agree that there are multiple areas responsible for the minimization of duplicates increasing the total number of responses from 7 to 10. The majority (5) place the responsibility on the admissions and registration areas. Three also listed their Health Information Management (HIM) and Information Systems (IS) teams as being responsible. Only two organizations responded that they had Enterprise Index Coordinators (EIC) or Enterprise Master Patient Index (EMPI) teams who are responsible for the duplicates.
All of the organizations reported a similar process for the location and merging of duplicates. However, only three of the seven organizations noted that they also provide some sort of feedback to the departments. One of those three relies on an auto-notification system to alert departments to update their records after a duplicate has been merged. The other two contact the person who created the duplicate to provide feedback to the employee directly. While the majority does not consider the provision of feedback to the employee/supervisor as part of the reconciliation process they do use it as a method to prevent recurrence.
All of the healthcare organizations reported having an electronic algorithm system to check for duplicates. However, only 5 of those run the check daily. The other two run it weekly, or monthly (except in the lab).
According to the survey results, the most duplicates are created in the Emergency Department and in the Registration/Appointment process. A small number (n=2) also responded that they are created most often in their outpatient services. Additionally, four of the organizations reported that they have systems that create duplicates (see ). For example, one has interfaces with legacy systems that cause duplicate creations while another has two different registration systems that interface. One of the three that reported they have no systems that create duplicates mentioned they had resolved that issue.
All seven healthcare organizations list name and date of birth as two of their primary unique identifiers. The next most popular identifiers were social security number and address (n=5), with three also using phone number. Medical record number, parents or next of kin, and patient signature are used by two organizations. Only one organization reported using sex of the patient as an identifier after experiencing an error where a patient was registered under her husband’s name.