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Making the Case for an EMPI Investment

By Gevik Nalbandian

For HIM professionals, patient identity management is one of the most challenging aspects of the job. Ensuring that medical records are complete, accurate, and current is an ongoing effort that requires a mix of sophisticated technologies and human intelligence.

Unfortunately, many health systems view patient identity management as a low-priority item, leading to underinvestment in this area of the HIT environment. But failing to recognize the importance a robust enterprise master patient index (EMPI) and comprehensive HIM process can create a cascade of data integrity problems that affect the entire organization.

Incomplete records and duplicate patient profiles—comprising up to 20% of patient records in some health systems—can negatively impact everything from patient safety and COVID-19 care to patient billing and collections.

Organizations that rely on Epic or Cerner are not immune to this issue. This is because master patient indexes within EHRs remain exceedingly limited in their ability to compare and link records from external sources. Without standards in place, EHRs continue to collect data in various formats that only serve to perpetuate the issue of duplicate and disparate information.

Health systems looking to provide safe, effective care while minimizing unnecessary costs simply cannot afford to sideline their patient identity management initiatives.

When making the case to the C-suite for more investment in EMPI technology and experienced staff, HIM leaders can cite a number of key challenges and opportunities that depend on trustworthy medical record data.

Improving Patient Safety and Patient Experiences
In 2017, the Partnership for Health IT Patient Safety found that 36% of patient record-related events involved diagnosis, while a further 22% were related to treatment. These events include interventions ordered for or performed on the wrong person, medications administered to the wrong individual, and mislabeled lab specimens that were either lost or incorrectly associated with a different patient.

When these mistakes result in harm, the consequences can be significant for the patient’s experience as well as the health system’s reputation and finances. A 2018 study from the Journal of Patient Safety states that that the mean total cost of hospitalization for patients experiencing lasting harm from a safety event was $16,021 compared with just $6,498 for patients who did not experience a negative event.

Patient frustration tied to billing inaccuracies, repetitive registration processes, and poor communication can also be diminished when demographic information is accurate and up to date.

Coordinating Care and Reducing Unnecessary or Duplicate Services
Coordination of care deteriorates when an individual’s health history is held captive across various disparate systems. Experts estimate that unnecessary testing and treatment costs the US health system $200 billion per year.

While not all of this spending is due to incomplete, incorrect, or out-of-date patient records, a 2017 study from PLOS ONE found that 40% of physicians cited difficulties with accessing patient data as a reason they ordered potentially unnecessary tests. And 12% said that it was easier to order a new test than communicate with other physicians. More than one-half stated that easier access to complete patient information is a major part of the solution.

EMPI technology can help health systems reduce unnecessary utilization, coordinate care, and improve communication across disparate organizations. A 2018 survey from Black Book Research found that while hospitals without EMPI tools reported record exchange match rates lower than 25%, health systems that leverage a mature EMPI infrastructure experienced match rates of 93% of registrations and 85% of externally shared records among nonnetworked providers.

Avoiding Delays in Billing and Patient Collections
Poorly managed patient identities aren’t just a problem for clinical care. Incorrect or missing data can also severely slow down the billing and collections process.

In the Black Book survey, respondents estimated that one-third of all denied claims resulted from inaccurate patient identification or information, generating $1.5 million in avoidable costs for the average hospital. Some of these costs can be attributed to the need for manual matching of services and billing codes to the correct patient, as well as missing demographic information, such as addresses and phone numbers, to facilitate collections.

Proactively Managing the COVID-19 Pandemic
COVID-19 is continuing to overwhelm hospitals and shut down communities. EMPI tools may be an effective secret weapon for slowing the spread.

With approximately 80% of COVID-19 test results missing necessary demographic data and one-half lacking contact information, using an EMPI with advanced matching algorithms and address verification technologies to match individuals with their results can speed up notifications, support meaningful contact tracing, and encourage responsible patient decision-making.

Reliable patient records are equally important for treatment, especially given the role of underlying health conditions in the severity and outcomes of COVID-19. As providers navigate overflowing emergency departments and packed ICUs, they need to be certain that their treatment decisions are based on correct, complete, and current data for each and every individual.

Some health system leaders may not immediately recognize that patient identity management is central to their organization’s efforts to combat the pandemic and deliver safe, high-quality care for all patients. However, HIM professionals have a strong argument to make in favor of additional investment in EMPI tools and medical record management personnel.

With the right technology and seasoned staff to implement strong data integrity processes, health systems can tackle some of the most costly and difficult challenges in the modern health care environment.

— Gevik Nalbandian is the vice president of software engineering for NextGate, a global leader in health care identity management.