Properly managed identity queues like roster management engines (RMEs) that mitigate errors and potential overlays lay the foundation for a well-maintained master person index (MPI) that minimizes issues and facilitates streamlined care coordination as part of an effective value-based care strategy.
Conversely, unresolved identity queue backlogs can have broad and costly implications for patient care, safety, and revenue integrity. It is a significant and growing problem, as hospitals and health systems struggle to stay ahead of queues that, for some, have more than doubled in volume. In fact, one health system recently reported a backlog of more than 100,000 identity interface errors, while another saw the volume of potential overlays in their queue balloon from 2,000 to more than 5,000 per week over the course of just a few months.
What’s more, hypersensitive identity management tools are exacerbating the problem. For one health system’s health information management (HIM) team, that meant identifying just 60 true overlays out of the approximately 400,000 potential overlay tasks it evaluated in the past year. Conversely, potential overlays and identity interface errors are being missed, because some electronic health record (EHR) systems lack the functionality or tools that alert end users to such errors.
Few HIM departments have the capacity to handle the time-consuming and resource-intensive task of effectively managing identity error backlogs. The intricate nature of these processes requires meticulous attention to detail and diverts focus from more critical tasks and strategic initiatives. Furthermore, new tools and reports being released to HIM that are designed to help address duplicate, overlay, and interface errors are actually contributing to the workload increase, requiring more reviews by individuals working with the same or fewer resources.
The Root Cause
The root cause of this seemingly sudden surge in identity errors can be traced back to several events, beginning with the COVID-19 pandemic and the accelerated adoption and use of patient portals. Furthermore, implementation of self-registration processes and internal workflows to accommodate telemedicine and vaccination appointments resulted in a rapid increase in overlays, duplicates, and other identity-related errors. Pandemic-related staffing shortages also played a role.
New fields to capture patient identity data, such as expanded options for the capture of sexual orientation/gender identity (SO/GI) data, are also in play.
Even EHR workflow tools designed to address patient identity management challenges cannot resolve all the issues without some human intervention. For example, Epic’s Possible Overlay Queue is a useful workflow tool that identifies and segregates potential overlays until they can be analyzed and either corrected or cleared. However, its sensitivity to any change to a patient’s demographic information can lead to an increased backlog volume, as every modification triggers an overlay task to be added to the queue.
Furthermore, when data such as order results and documents can’t be automatically filed into an existing medical record because of a mismatch or fuzzy match on demographic, Medical Record Number (MRN), or other patient-level data point, these messages error out and must be manually reviewed and resolved. If they’re not resolved, they can result in repetitive orders, duplicate tests, and other issues that lead to denied claims.
Taking Charge of Errors
The good news is that there are several policy, process, and technology actions a healthcare organization can take to reduce the volume of identity errors and prevent new backlogs from forming. One is to outsource the initial cleanup and/or ongoing management of patient identity queues to a vendor or partner with experienced staff, overseen by credentialed professionals. Short-term MPI management support should also be considered during such activities to ensure integration of clean data and quick turnaround times.
Outsourcing to the right vendor allows HIM departments to reclaim valuable time and resources that can then be refocused back on core tasks and responsibilities. Quickly eliminating backlogs and preventing their return via outsourcing can ultimately reduce operational costs, avoid potential reimbursement denials, and eliminate patient safety issues created by missing medical history like duplicate tests and other adverse events.
Healthcare organizations can also:
- Invest in Staff Training – Provide comprehensive training to enhance HIM professionals’ identity management skills. Keep staff updated on changes in patient data capture fields and the use of EHR workflow tools to reduce errors caused by lack of awareness.
- Prioritize Staff Resources – Allocate adequate staff resources to address identity queue backlogs and ensure that HIM departments have the capacity to handle the volume of tasks. Also, consider hiring additional staff or redistributing existing resources to focus on resolving identity errors and preventing the backlog from growing.
- Collaborate Across Departments – Foster collaboration between IT, HIM, and other relevant departments to collectively address identity management challenges. Also, establish cross-functional teams to develop and implement solutions that consider the perspectives and requirements of different stakeholders.
- Implement Robust Data Governance – Establish a strong data governance framework to ensure the accuracy and integrity of patient data throughout its lifecycle, including ongoing quality checks to ensure the accuracy of any automation and other patient matching tools, including the American Health Information Management Association’s (AHIMA’s) Naming Policy Framework and the Project US@ AHIMA Companion Guide.
- Enhance EHR Workflow Tools – Collaborate with EHR vendors to fine-tune sensitivity of algorithms to reduce false positives in the identification of potential duplicates and overlays, and to customize workflow tools that better align with the organization’s specific needs and processes.
- Leverage Third-Party Data – Leverage third-party data like historical addresses and phone numbers obtained from outside vendors to help prevent and accelerate remediation of overlays.
- Invest in Enhanced Patient Matching Tools – Biometrics and other patient matching technologies can prevent the introduction of identity errors by improving accurate identification during front-end registration processes.
- Automate Data Matching Processes – Explore, implement, and closely monitor advanced technologies such as machine learning and AI to automate matching and reduce the reliance on manual reviews. Integrate systems that allow for automatic filing of order results and documents into patient records to minimize errors related to mismatched data.
- Utilize Analytics for Insights – Leverage analytics tools to gain insights into patterns and trends related to identity errors, and to identify root causes.
- Regularly Monitor and Evaluate Processes – Implement a continuous monitoring system to track the performance of identity management processes and identify areas for improvement. Regularly evaluate the effectiveness of implemented solutions and work closely with IT staff or vendors to optimize processes, as even seemingly minor errors can have significant and widespread impacts.
It’s also important to include patients in any initiative to maintain clean patient identity queues. Implement patient education programs to encourage accurate self-reporting of demographic and other relevant information, and promote the importance of maintaining current and accurate information. This could include providing staff with talking points to help them engage in patient discussions.
Strengthening the Bottom Line
To avoid the range of impacts unresolved identity errors can have on a healthcare organization’s financial health, integrate identity error queues into an overall MPI management strategy that includes outsourcing or dedicating appropriate internal resources and developing proper workflow processes to eliminate backlogs and sustain ongoing management.
Doing so empowers organizations to optimize operations that are being weighed down by unresolved patient identity errors while generating measurable cost savings, mitigating financial setbacks, and creating room for strategic investments in areas that truly matter.
About the author:
Rachel Podczervinski, MS, RHIA, is Vice President of Professional Services with Harris Data Integrity Solutions and a member of the AHIMA Board of Directors. The viewpoints expressed in this article are that of the individual and are not being made on behalf of AHIMA.
