As the HCIS landscape shifts, we are often finding ourselves involved in major upgrade and conversion endeavors on behalf of our customers. Whether upgrading to the latest version of MEDITECH, or moving to a completely new platform, our sites are confronted with a host of challenges. While this threatens to be a frustrating process, it also presents unique opportunities to improve inefficient workflows, normalize dictionaries, retire obsolete reporting methods or legacy applications, and ensure that the mistakes made in the current system are not inherited during the upgrade process. Preemptive decisions need to be made, regarding resource allocation and timelines to ensure goals can be accomplished at the appropriate stage of the conversion process. When upgrading MEDITECH, consolidating our Master Patient Index (MPI) should be taken into consideration.

Over time, an MPI database inevitably accrues duplicate records, due to misidentification or workflow errors, and if we hesitate before starting our reconciliation effort, we can easily miss the window of opportunity to move forward with a clean MPI. We all understand the importance of eliminating duplicate records to ensure the data integrity of each patient’s medical history, but there are other considerations. Improved operational efficiency and cost reduction are major factors. Missing this window will complicate the process of reconciling duplicates in the future. For example, when upgrading to a new version of MEDITECH we often need to maintain a historical link with our previous systems. After conversion, any duplicates merged in the new HCIS will also need to be merged in the prior HCIS to maintain the accuracy of this historical link, but if the records are merged prior to conversion, this extra step is unnecessary.

It is important not to minimize the effort involved with the resolution process, as this is the primary reason for missed timelines. There is no fully automated solution that will ensure there is no risk of creating additional errors, such as patients merged in error. Our focus needs to be on finding ways to be as efficient as possible during the resolution process, and on approaching the problem in a way that maximizes the results of our time spent on each task, without creating additional risk.

Our response to the challenges posed by the duplication resolution effort is our MPI MergeIT™ application. MergeIT™ integrates with the existing MEDITECH tools used to reconcile duplicates, to enhance and facilitate the process of accelerated resolution, without the risk of an unintended or erroneous merge. MergeIT™ generates customizable worklists of potential duplicates by comparing demographic data at the database level. This lets us prioritize the most likely duplicates and defer the potential duplicates that will need more investigation to a second phase of the process. When a duplicate is identified, it can be immediately handed off to the MEDITECH merge routine, to eliminate any need for redundant manual entry, and to ensure that all values are merged as intended. As the selection criteria is expanded to the second phase, any potential duplicates that are confirmed to be unique, can be permanently filtered from the identification routine, to ensure we never needlessly investigate the same medical record number combination more than once.

The upgrade process does not have to be daunting, and presents many opportunities, but these opportunities can be easily missed if we don’t take initiative and engage the necessary resources early enough in the process. To ensure we can consolidate our MPI prior to conversion, and that we are not creating additional work for ourselves and inheriting the corruption present in our current system, we need to begin well before the conversion is underway.

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