EMPI called solution to repeat registrations

Insurance, override’ decisions necessary

As burgeoning health systems strive to streamline operations and enhance customer service, more and more often the solution involves establishing an enterprise master person index (EMPI). That’s the case at Providence Health System in Portland, OR, which is in the midst of implementing an EMPI that is expected to be up and running by the end of 1999, says Barbara Wegner, CHAM, regional director for access services.

Armed with the desire to eliminate time-consuming repeat registrations, Providence partnered several years ago with Atlanta-based McKesson-HBOC to develop a common registration system, Wegner notes. That system — which was to encompass all parts of the multi-entity health system — was abandoned because of the overwhelming technology issues involved, she says. The more realistic alternative for systems seeking to streamline registration across an enterprise, she says, has become the EMPI.

"Nobody is very close to a common [enterprise] registration system," she points out, because the registration needs of physician offices differ so greatly from those of hospitals. What seems to make more sense, she says, is the EMPI, which interfaces with different registration systems and allows them to share demographic data.

Faced with operating multiple entities whose computers can’t "talk" with each other — including seven acute-care hospitals, close to 100 physician groups, urgent care and occupational health clinics, and Oregon’s third-largest health plan — Providence made the decision to purchase an EMPI from Eclipsys Corp. in Delray Beach, FL.

Basically, the software feeds demographic data about the patient from the hospital’s McKesson-HBOC STAR registration system or the physician practices’ registration system into the EMPI, explains Joan Deardorff, quality and training analyst for access services.

Physicians’ office staff can pick a patient off the MPI and see the information that was entered for that patient during the last visit to the hospital, Deardorff says. The patient won’t be asked again to provide such basics as address, telephone number, and employer because that information will "flow" into the registration from the EMPI.

But before the EMPI becomes a reality, there are issues common to most health care systems that must be worked out. Those include:

• deciding whose information will prevail and which data will be in a "view only" mode;

• making sense of different insurance coverage;

• training staff on new Windows-based products.

In the discussion of whether the physician’s office information will override the hospital’s data or vice versa, "the one we struggle with the most is the insurance," she notes. "We have to be able to say, We want this from the physicians, but they don’t want it from us.’ The [hospital and physician] computer systems hold insurance so differently that we’re unable to map that information back and forth."

Physicians’ offices use a different part of Medicare for their billing, she points out, and they don’t have the "pro fees" category that allows hospitals to bill for the physicians who read biopsies. "And patients may use different insurance coverage at different times. If a patient comes in for treatment after a motor vehicle accident, [the registrar] might not want to choose the insurance used at the physician’s office for the last visit."

For those reasons, none of the insurance information will flow automatically between systems, she says. "It will be view only’ unless the registrar asks for it to flow.

"The [registrar] can verify insurance coverage by saying, You have the Providence Health Plan,’ and when the patient says yes,’ the registrar can select that information from the MPI," Deardorff adds.

Just identifying the right person is a huge challenge with a million-plus database, Wegner points out. "Typically, physicians’ offices may know a person as Dick Wegner, while the hospital uses the full legal name, Richard Arthur Wegner. And maybe there’s a nickname. Right away you have big problems. The person may be in the database many times."

To address that issue, she says, Providence is working to "scrub" the data in the individual physician and hospital MPIs before combining those data and doing another scrub, which involves identifying and correcting duplicates.

Because registration staff are unfamiliar with Windows-based products, the training aspect of implementing EMPI "will be a real challenge," Deardorff says. "How to select the patient, what they do and don’t need to ask will be a little different."

In the physicians’ offices, "there will be a whole process change. They currently don’t do the registration when the patient walks in the door, but they will have to do it real time’ now," she says.

Physicians typically do not collect the same level of information acute care facilities do, Wegner points out. Hospital registrations have many more data fields, with places for a relative to contact in case of emergency, and then a back-up if that person can’t be reached, she adds. "We need more in-depth information, and there is a reluctance on their part to collect everything we need. They’re not set up for that kind of interview."

Details continue to be worked out in team meetings concerning what will and will not be shared between systems, Wegner says, with an all-day workshop scheduled for developing "business rules." It’s clear, though, that registrars at acute care facilities still will need to ask patients for more information than those at physician offices, she adds.

There will be many clinical benefits of the EMPI, Wegner says. "There is the ability to find a patient record across all settings. If you’re registering somebody that has just been to the hospital for a blood test, [the software] would search the EMPI, bring that information to the screen, and script it all in for you — you do not have to re-enter it. The same thing would happen in a physician’s office."

(Editor’s note: Look for more information on Providence Health System’s implementation, as well as EMPI case studies from other organizations, in future issues of Hospital Access Management.)