Hayes Review: Summer 2009

Reducing Interface Errors:  Getting Patient Registration Right the First Time

By Rosalinda Montemayor

Seamless and safe healthcare relies on an organization’s ability to pass information from one system to another. The vast majority of information that is shared between healthcare information technology solutions is accomplished with the assistance of an application interface engine (AIE). Over the years it has become common for vendors to deploy lightweight AIEs into their applications.   For example,  Allscripts’ Enterprise EHR utilizes an interface engine called ConnectR.  All messages received by or sent from Enterprise are managed via ConnectR.  One of the advantages that these lightweight engines provide is a robust method for interrogating messages to ensure that they meet the requirements of the receiving system.  When information fails to meet the requirements, an error message is created and stored along with the message until someone can intervene manually and correct the issue. 

The interface engine must be monitored throughout the day to ensure that error messages are addressed in a timely manner.  Some of the most common registration errors are:

• Non-recognized MRN
• Patient names, DOB, etc. do not match
• Ancillary result codes are missing from the respective dictionary
• Ordering provider and receiving provider do not match
• Date of service errors, etc.

Corrections can take minutes or hours, and may require additional staff and/or overtime pay for existing staff.   To help your organization reduce this costly risk, complete the following steps:

• Evaluate and identify clinical workflow processes.
• Identify required data elements between systems to file the transaction, i.e., patient name, date of birth, patient address, PMS generated MRN, enterprise patient identifying number (which is utilized for all systems), MRN generated from the source system, i.e., lab system, radiology system, etc (if applicable), SSN (not always utilized), and sex of patient.
• Verify that the data elements to be used are elements that both the source and target systems will utilize to ensure a match is found when the initial transaction is sent.  This will also help minimize outbound transactions from a target system to a source system – i.e., from an EMR orders module to the receiving (source) service.
• Identify a common patient number (MPI, EMPI, etc) that can be utilized enterprise wide and act as the primary data element to match each transaction against.  This minimizes transaction delays.

It is also important to have procedures in place to ensure consistency. Here are some process suggestions:

• Develop and communicate a clear policy that identifies required search techniques prior to creating or identifying an existing registration.
• Implement a policy that identifies the required information to be verified for existing registrations.
• Create a training program for new employees and refresher classes for existing employees.  The refresher classes should be annual and mandatory for all staff members who have the ability to create and/or modify a registration.  Registration accuracy should be reportable as part of the employee’s performance review.
• Compile a duplicate registration report at least once per day.  A clear timeline must be identified and met to have the duplicate registrations fixed.
• Provide ways an end user can report a duplicate registration, i.e., a duplicate registration hotline, sending an email to a designated address, or creating a system generated notification (if one is available) via the PM system.
• Ensure that once a duplicate registration has been identified, it is no longer accessible or clearly identified message such as, for example, “THIS IS A DUPLICATE DO NOT USE”.
• Merge patient information in a timely manner and clean up any transactions that did not merge.
• Create a method to communicate duplicate registrations across the enterprise.  This is important when other systems have their own registration process separate from the PM system.
• Understand and document all points of patient entry into a practice.
• Verify information at each point of contact.  Patients may get irritated but it is a necessary step to ensure the integrity of your data. 

Your registration database is the foundation of patient information. System efficiencies are critical to accurate and timely information exchange, which in turn is critical to patient care.

About the Author
Rosalinda Montemayor is a healthcare consultant at Hayes with more than ten years of management experience in an outpatient academic healthcare environment. She works with a variety of HIT applications, including Allscripts and GE/IDX.