Dirty MPIs and the Patient Experience

By Megan Pruente, MPH, RHIA, Director, Professional Services for Harris Data Integrity Solutions

The patient’s experience is an often-overlooked aspect of patient identification and master patient index (MPI) management. But the impact of a compromised MPI on patient safety and satisfaction is significant. After all, would you trust a hospital that doesn’t know who you are?

Compromised Safety
As discussed in our white paper, People Matching in Healthcare: Challenges, Impact, and Solutions, an incomplete or inaccurate medical record or an MPI compromised by duplicates and/or overlays can lead to patient safety issues including medication errors, incorrect treatment, and delayed diagnoses. In a survey by HIMSS and Patient ID Now, 70% of respondents agreed that problems with patient identification issues caused patients to undergo or receive duplicative or unnecessary testing or services.

On a broader scale, patient misidentification can impact response to public health emergencies, with missing, incorrect, and duplicate data hindering contact tracing, vaccination, and public health reporting efforts. During COVID, we heard of vaccination sites being denied additional vaccines because patient record systems erroneously showed patients as not having received previously administered vaccinations.

The safety issues related to patient misidentification and medical record problems, according to Patient ID Now, are “so dire that one of the nation’s leading patient safety organizations, the ECRI Institute, named patient misidentification among the top ten threats to public safety.”

Frustrations and Delays
While patient safety is a top concern, it is not the only impact a dirty MPI can have on a patient’s experience. Duplicate records can also result in frustration and dissatisfaction among patients who are stuck dealing with billing mistakes and navigating the red tape that comes from insurance eligibility and verification issues – something 71% of the HIMSS/Patient ID Now survey respondents say complicates member enrollment and patient admissions. 

Duplicate records and other patient misinformation problems can also prevent patients from taking full advantage of patient portals, the use of which has been skyrocketing since the early days of the COVID-19 pandemic. According to research from PYMNTS and Experian Health, two-thirds of consumers currently use patient portals, and 32% of those who don’t would be very or extremely interested in doing so if they were offered by their providers.

The challenge for healthcare organizations, however, is what to do when a patient establishes a portal account or attempts to schedule a visit with information that doesn’t match their existing medical record. For many, the answer is simply to prevent the portal from being used until the discrepancy is resolved. For others, the visit is allowed to be scheduled or the account created – along with a duplicate record that must then be resolved on the back end. Further, a duplicate portal account lacks the complete history of care that would otherwise be visible in the portal to the patient, such as lab results, visit notes, etc. 

Either solution can wreak havoc on patient satisfaction and, in some cases, safety. Either they are left frustrated in their attempts to utilize a powerful patient tool or their chances of being on the receiving end of a bad bill, unnecessary testing, or medical errors increase exponentially due to the duplicate record.

SO/GI Challenges
A deeply personal patient identity/MPI issue that relates directly to the patient experience is the capturing of sexual orientation/gender identity (SO/GI) information, particularly if the patient’s preferred name no longer matches their legal documentation.

Unless the healthcare organization’s EHR provides the option to include both the legal and preferred name and gender – which most still do not – healthcare organizations need to get creative to ensure they are properly referring to the patient. Some of those options include switching between the patient’s preferred and legal names between the visit and filing with insurance or creating a custom field on patient records to record their preferred name.

Regardless of the solution, any time identifying information changes on a patient’s record, it opens the door to creation of a duplicate record.

Minimize Pain Points
From scheduling to check-in and during the visit, to getting accurate and timely test results, and managing payment options, a positive patient experience requires positive patient identification. Thus, minimizing patient pain points requires special attention to the integrity of patient information and the MPI and the impacts it has on the overall patient experience.

The best results will come from a “people-process-technology” approach. This includes not only policies and procedures designed to prevent creation of duplicates, but that also encourage collaboration across all departments, systems and stakeholders that come into contact with the MPI. A data integrity team should also be established to focus on duplicate prevention.

In terms of technology, automate as much of the MPI maintenance process as possible with solutions that enable continuous end-to-end protection and operate in multiple environments and at multiple stages throughout the patient record process. They should also leverage advanced deterministic and probabilistic matching algorithms to analyze and clean patient data before a record is updated or duplicate created. Automated processes should be continuously monitored to identify when changes are needed to workflows, data elements, etc. and regular quality assurance reviews of automated results should also be conducted.