Information Governance & Standards

1.  Duplicate MRN clean up

Posted 06-02-2017 14:50

This question is for those who did a mass clean up/merging of duplicate MRNs as my facility is working on this.  There are about 250K MRNs, with 1.6 FTE.  What is a reasonable rate of the clean up process?  Is it possible to be completed within 4 months including research and validation?  Any input is greatly appreciated.   



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Leah Beck, RHIA
Supervisor, HIM
Arrowhead Regional Medical Center
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2.  RE: Duplicate MRN clean up

Posted 07-19-2017 18:03
​Hi, Leah - there are several factors that you may need to consider, such as how many other systems will need to be updated in addition to your EMR and whether the 1.5 FTE's will be solely dedicated to the clean-up process.  Due to the number of applications that our staff have to update, our staff can clean up about 27/hour (at a minimum).

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Jami Woebkenberg, MHIM, RHIA, CPHI
Director, HIMS
Banner Health
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3.  RE: Duplicate MRN clean up

Posted 07-24-2017 12:23
​Hi Leah,
I agree w/ Jami -- there are several key factors to consider that can definitely impact how long a project like this can take.  When I was managing a Data Integrity team at a large health system, the staff were averaging about 20 to 25/hr for research and merging, however, they were not merging in any other downstream systems.  One way to prioritize would be to start with MRN's having a last visit date of 5 years or sooner, using some criteria to "fix" your more active patients.

At Just Associates, we certainly can provide outsourced MPI clean up work if you find that the in-house approach is moving to slowly. :-)

Good luck with your project!

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Karen Proffitt
VP Consulting Services
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4.  RE: Duplicate MRN clean up

Posted 07-25-2017 16:05
​It probably varies by site or situation.  For example we are also reviewing microfilm/fische.  We're taking about 12-15 minutes per duplicate to research and remediate, that's an average.  Maybe do some "time studies" to come up with your own average.

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Darlene Schaffer
Asst Director, HIS
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5.  RE: Duplicate MRN clean up

Posted 07-25-2017 09:32
​​Hi Leah,
It's been a while since we performed our duplicate clean up but, as others have indicated, there are many factors in determining if the number of FTEs is appropriate and what sort of productivity rate to expect.
At the time our clean up was performed, we had just under 3 million patients across the enterprise - feeding from 7 siloed MPI systems (7 facilities).  Each facility had a data steward to resource the project, BUT they were only partial FTEs for the project.  In addition to that, each facility had a different duplicate rate (we ranged as low as <1% to as high as 11%).  I think we gave them about 4 - 5 months to clean up the duplicates identified.  The one site with the highest duplicate rate had a team of temps, hired and trained by the vendor of the EMPI system we were implementing, to aid in clean up there.  Once the clean up was completed we determined that 4 FTEs could reasonably manage on-going duplicate support, along with other data integrity tasks.  The productivity rate we utilize today is around 11 merges/hour.  That does include tasks reviewed that do not get merged though.  Additionally, that rate includes a weighted adjustment for low scoring duplicate tasks which may take longer to review.....as well as an adjustment for higher scoring tasks which may not take as much time to complete.  Since then, our EMPI has grown....so we are just under 4 million patients now.  The team has grown too, but we primarily manage chart correction these days. I really only have 3 people working on duplicate tasks regularly (and even still, it's not all the time).
I would assess your staffing needs based on how many duplicate tasks you've identified that need to be reviewed....plus the number of systems that need to be reviewed and reconciled in the merge process, along with your timeline....

One other thing to consider is the plan AFTER the clean up is complete.  Once the system is clean, you need to maintain it.  Duplicates can quickly rack back up when no one is watching.

We were fortunate, as an organization, to recognize this early on.....before we began the long process of implementing a true enterprise EMR.  Also before we began integrating ambulatory practices in with our acute population.  All those patient loads from ambulatory systems were made so much better by having a clean MPI.

Let me know if you have any questions!!  Hope your clean up is a success!

Jennifer

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Jennifer Schipper
Corporate Manager, Data Integrity
Franciscan Alliance
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6.  RE: Duplicate MRN clean up

Posted 07-26-2017 17:22
A very timely discussion given the AHIMA Annual Convention is just 2.5 months away, and there are presentations and roundtables exploring HIM practices in patient/provider identity management, data governance, and innovation in this area.

Below are my thoughts to some of the focus areas:
  • The time required to validate a potential duplicate or overlay, and execute the merge or linkage will vary based upon the scope of work. The use of business process software may save time and will certainly standardize and streamline the process, but it is not widely used today.   I've seen standards of 2-3 minutes per record (carefully consider if you are counting records or tasks or linkages or sets) to upwards of an hour.  Obviously the upper estimate is driven by the validation process, potentially un-merging records for an overlay, and if any corrective action is taken in the downstream systems.  The lower end of the spectrum probably reflects just the source systems or the MDM/EMPI software being updated.  
  • Many clients use a range of 50-100 records per day for a FT person, but ranges will vary widely as Jennifer has nicely articulated.  Obviously an organization has to clearly document the procedure and goals and then assign a work standard.  
  • I whole heartedly agree with Jennifer that organizations need to carefully consider the ongoing EMPI/MDM staffing needs.  "One and done" is certainly NOT an appropriate principle to apply to the critically important patient identifier and the associated clinical and financial data that today is essential to analytics, research, pop health, care coordination, etc.  I favor a centralized HIM team for this ongoing effort, as centralization supports funding, accountability, metrics, and a standardized approach.  

Good luck, Leah!

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Lorraine Fernandes, RHIA
Founder and Principal
Fernandes Healthcare Insights
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7.  RE: Duplicate MRN clean up

Posted 08-09-2017 16:17
Thank you much!  ​I appreciate all your very helpful input.  Looking forward to attend similar topic at AHIMA CON.

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Leah Beck, RHIA
Supervisor, HIM
Arrowhead Regional Medical Center
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