Health Information Technologies and Processes

MPI Patient Merge

  • 1.  MPI Patient Merge

    Posted 28 days ago
    Our HIM department is currently working on a Performance improvement project involving patient merges. I have a few questions about how other HIM Departments handle inpatient merge requests:

    What is your process for merging patient records?

    Do you merge or change/update the name while the patient is in-house? 

    Can your system merge two MRNs while during an active admission and staff are in the chart?

     What roles in your institution other than HIM can create new patient records?

     Are there any precautions that you have to take prior to making any change or merging, i.e. verify with the blood bank, pharmacy, coordinated efforts with nursing to change the ID band, etc.

    Thanks in advance for sharing your information.  



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    Karen Baytops
    Assistant Director Him
    Dupont Hospital for Children
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  • 2.  RE: MPI Patient Merge

    Posted 21 days ago
    Hi Karen,

    Merging records is a joint effort between HIS and Patient Access at our facility. PA will enter duplicate merges into a work queue that HIS works. The purpose of PA assisting is to do the initial review to ensure that the patients are in fact a duplicate by reviewing ID and demographic information.

    Our system does allow us to merge while a patient is in-house but it against our policy to do so because it causes major issues on the units and other areas. So with that being said we only merge upon discharge.

    When we merge we send a notification to the Blood bank and Radiology department of any records merged that day.

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    Joanna Broussard
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  • 3.  RE: MPI Patient Merge

    Posted 21 days ago
    Thank you so much for taking the time to respond to my questions.  Very much appreciated.

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    Karen Baytops
    Assistant Director Him
    Dupont Hospital for Children
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  • 4.  RE: MPI Patient Merge

    Posted 19 days ago
    Edited by Laritha Boone 19 days ago

    Hi Karen,

    Below are my responses to your questions. My organization consists of 5 adult hospitals and 1 children's hospital. We also have some of our owned provider groups using the same EHR- Cerner.

    What is your process for merging patient records? MRNs are merged always keeping the mostly recently updated MRN. This is usually the newly created MRN.


    Do you merge or change/update the name while the patient is in-house? Yes. There is a caveat. For unknown pts at our children's hospital we wait 48 hours to make changes to the pts name and merge the record. This is due to these pts being traumas. They may be in and out of the OR multiple times during those critical hours. We do not want to cause an issue for downline ancillary depts. such as radiology, blood bank, etc. if the name doesn't match specimens, films, etc.

    Can your system merge two MRNs while during an active admission and staff are in the chart? Yes

    What roles in your institution other than HIM can create new patient records? Any associate that has access rights for registering patients. This is not an exhaustive list but these are some of the job titles that can create MRNs: Pt. Access Services/Registration, Centralized Scheduling, Ambulatory Clinic Registrars, Out Pt testing areas such as radiology, mammography, etc. There are some areas that RNs and EMTs can register pts as well.

    Are there any precautions that you have to take prior to making any change or merging, i.e. verify with the blood bank, pharmacy, coordinated efforts with nursing to change the ID band, etc Our process is to merge the records, then notify the downline areas listed if the pt is currently in-house. We always keep the active, survivor MRN the one that the pt is in-house which is usually a newly created MRN. If the case is an overlay due to an encounter move from one MRN to another then we ask Pt Access to print new armbands and labels, sending them to the floor.



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    Laritha Boone, MBA-HCM, RHIA
    Manager, HIM eHealth and Data Integrity
    Methodist Le Bonheur Healthcare
    President-Tennessee Health Information Management Association (THIMA)
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  • 5.  RE: MPI Patient Merge

    Posted 18 days ago
    Hi Laritha,

    We are in the process of integrating Cerner into our system. Our organization structure is similar yet different but the information snapshot you've supplied to Karen's questions has been well received. Much of what you said resonates with our team's effort in handling the integration and sunsetting our old EHR system.
    Thank you for sharing.

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    Kelly Randell
    DRG Analyst
    [G2 Corporation]
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  • 6.  RE: MPI Patient Merge

    Posted 18 days ago
    Kelly,

    I'm glad I could be of help!

    I do have a couple of things to add. We also have Ambulatory Clinics who use the Cerner Revenue Cycle tool as well. Thoses merges are processed the same way.

    Also we have other organization owned provider groups who are not on Cerner. Those merges are handled in their respective systems by their respective teams. We are investigating tools for future integration across our enterprise where we can have all the different EMRs interfacing properly.

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    Laritha Boone, MBA-HCM, RHIA
    Manager, HIM eHealth and Data Integrity
    Methodist Le Bonheur Healthcare
    President- Tennessee Health Information Management Association (THIMA)
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  • 7.  RE: MPI Patient Merge

    Posted 18 days ago
    Laritha,
    We have a combination of 3M Modules and the arriving Cerner integration going globally across our facilities. This has been ongoing for several years already and not every facility we have has gone live with Cerner. As you mentioned working on the integration of MR data to cross into your organization's system from outside sources is challenging. I already sense that your organization must have developed protocols to ensure that changes are executed expeditiously between facilities you have BAs with. It is a challenge. However, your team can find the right answer as you have indicated. Me personally, when i perform high volume MR documentation audits using 3M technology, I make it my priority to look for integrated errors and glitches and report them immediately and exclude the MR documentation from auditing until resolved. Thank goodness, the integration efforts by design and implementation from our software engineers and the like have really stepped up to the plate and have been thorough in catching these glitches and errors early. However, they still occasionally happen.

    The ambulatory facilitation is an important aspect of your facility. I wish your team much success in finding the critical pathway to follow using Cerner integration or other interim software platform to meet and exceed the expectations your organization needs to continue your RCM efforts.

    Enjoy your Holiday Weekend!

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    Kelly Randell
    DRG Analyst
    [G2 Corporation]
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  • 8.  RE: MPI Patient Merge

    Posted 18 days ago
    Thanks so much for the feedback.  Our process sounds very similar to yours.  Our organization is trying to find a feasible method that will allow us to complete merges in the inpatient environment without causing harm to the patient, etc.

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    Karen Baytops
    Assistant Director Him
    Dupont Hospital for Children
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  • 9.  RE: MPI Patient Merge

    Posted 11 days ago
    Hi Karen-
     Our organization has just gone through a major implementation integrating our 1 Acute care hospital with 28 Physician and Surgeon practices and a Cancer Center.  Each had their own record numbering system and consisting of the same amount of digits. There were MANY patients who had been seen at multiple offices and had different MRNs at each facility and there were many overlapping MRNs that had to be re-assigned. Our general procedures are similar to how Laritha laid out her organization


    What is your process for merging patient records? MRNs are merged always keeping the mostly recently updated MRN. This is usually the newly created MRN.


    Do you merge or change/update the name while the patient is in-house? NO.  We do not merge while the patient is in-house.  We use the Allscripts Sunrise platform and have found that charges do not merge correctly, Pyxis does not merge MRNs and med dosages are often rejected, open orders and notes don't transfer and the providers have to re-do many steps that they already grumbled about doing the  first time.  Most of the consents for treatment have already been signed and scanned with MRN/acct they were registered under.  Our 72 hour rules are thrown off, lab results fail to file and end up in an error queue - it is a mess.  Our workaround if the patient has had recent visits, is to move the discharged visit to the current MRN which updates allergies, problem list, current meds and recent care plans, without interfering with the current treatment.  The coding Manager is asked to ask her staff to alert Data Integrity as soon as the patient hits their queue to be coded and the charts are merged prior to coding in order to capture the most appropriate codes and DRGs.


    What roles in your institution other than HIM can create new patient records? Any associate that has access rights for registering patients. This is not an exhaustive list but these are some of the job titles that can create MRNs: Pt. Access Services/Registration, Centralized Scheduling, Ambulatory Clinic Registrars, Out Pt testing areas such as radiology, mammography, etc. There are some areas that RNs and EMTs can register pts as well.

    Are there any precautions that you have to take prior to making any change or merging, i.e. verify with the blood bank, pharmacy, coordinated efforts with nursing to change the ID band, etc N/A

    I have to say I am jealous, because I feel like the system should be able to handle a merge, particularly since many patients arrive at the ED unresponsive, or otherwise unable to communicate very well and often it is those patients that the providers need to know the history about to provide the safest care.

    I am interested in what systems others are using besides Cerner.  I used Cerner Sorian at another job and really liked it.




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    Susan Mason
    Clinical Analyst
    Atlantic General Hospital
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  • 10.  RE: MPI Patient Merge

    Posted 11 days ago
    Hi Susan
    Thanks for your response. This is such an interesting topic, and I am enjoying the responses we are receiving.  We are a totally Epic shop.  We can perform in-patient merges, but it is a tedious process.  Our practice has been to wait until the patient has been discharged, but recently - we have received some complaints from others in the organization; citing this as a patitent safety issue, which is why we have now made this a performance improvement project to review.  When we attempt to merge while the patient is in-house, we reach out to Medical Imaging, the Blood Bank, Pharmacy, Nursing Unit, etc. to determine if any there would be any downstream effects if the merge was made.  We have several Associates in the organization that have the ability to merge and change patient names, and as part of our project - we are taking a deeper dive into that process also - who really needs to  have the abilty to perform this function.  Thanks again for your responses, and from everyone else that has responded to my questions.

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    Karen Baytops
    Assistant Director Him
    Dupont Hospital for Children
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