This podcast discusses the issues of duplicate medical records and record overlays in healthcare. It covers how overlays occur when information from two patients is combined into one record, while duplicates are when a patient has more than one medical record. This can cause safety risks if a patient receives care based on the wrong information. The podcast also discusses how duplicates and overlays impact costs, data quality, and revenue for healthcare providers. It explores challenges in accurately measuring the scope of these problems and potential solutions including identity management technologies.

1. M2SYS Healthcare Solutions
Free Online Learning Podcasts
Podcast length – 52:39
The Impact of Duplicate Medical Records and Overlays on
the Healthcare Industry with Beth Just, President and CEO of
Just Associates

2. Topics Covered in Podcast:
What are overlays and how are they different from duplicate
medical records?
What are the implications of overlays and duplicate medical
records and why do they pose a threat to patient safety?
What is the actual % of duplicates and overlays at medical
facilities vs. what industry experts say and why is there a
discrepancy?
What impact to overlays and duplicates have on a medical
facility’s revenue stream and billing cycle?
What are the potential implications of duplicates and
overlays on healthcare data integrity and the ability to raise
the quality of care and lower costs?

3. Topics Covered in Podcast (continued):
How much time and resources are needed to correct duplicates
and overlays? What additional steps are needed for prevention?
What technologies today are predominantly used to eliminate
duplicates and overlays and what others are viable solutions?
What priority do hospitals place on addressing the issue of
duplicates and overlays?

4. • Overlays occur when two different patient records end up in one medical
record as opposed to duplicate records which occur when a patient is
assigned more than one medical record number
What are Overlays vs. Duplicates and what are their
Implications?
Implications:
• Duplicates – patients are treated with missing information – could be
dangerous (e.g. – incorrect blood types, severe allergies)
• Previous tests can be missed – physician has incomplete information
• Tests can be repeated – most common example was chest X-ray –
this raises the cost of care and can be particularly dangerous (e.g. –
unnecessary exposure to radiation in children)
• Potential to have large financial impact on ACOs
• Decreases available staff and resources to treat other patients
• Delay in treatments

5. What are Overlays vs. Duplicates and what are their
Implications? (continued)
• Overlays
• Cause a huge patient safety risk – treating one patient
with another person’s record
• Quality of care problems created are numerous and extremely
dangerous
Did you know?
It can take over 100 hours to fix one
electronic record overlay!

6. Why are Overlays and Duplicates Particularly
Troublesome for Children’s Hospitals?
• Higher risk for duplicates and overlays to be created at pediatric
hospitals
• Children can’t speak for themselves
• Care giver may not know accurate demographic data of child (e.g. –
DOB), child has no formal mode of identification
• Can lead to adverse medications and duplicate diagnostic tests
Did you know?
Incorrect dates of birth are 10% more likely
to occur on pediatric records than on adult
records.

7. Reconciling Duplicate/Overlay Estimates with Real
World Results
• Many industry resources (e.g. AHIMA) say hospitals average a 8% - 12%
duplicate medical record rate
• Rise of IDNs is exponentially increasing size of EMPIs and data indexes
from disparate sources causing more overlays and duplicates
• The actual duplicate and overlay rate depends a lot on how duplicates
and overlays are measured, based on the strength of underlying identity
algorithms – standard hospital information system versions are typically
not strong – hospitals tend to know about just 20 – 30% of all duplicates
that truly exist
• Industry researchers tend to rely on more sophisticated, error tolerant
identity algorithms and provide more accurate measurement

8. Impact of Duplicates/Overlays on Revenue
Fee for Service:
• Revenue impact centered on delays in issuing the bill due to problems
with demographic patient data integrity
• Inability to combine bills for visits occurring within 72 hours risking
charges of fraud from Medicare/Medicaid
• Inability to identify patients who owe, or may have bad debt
ACO Model:
• Larger impact and higher risk to providers and groups
• Can’t longitudinally trend data for one patient to assess care
received and determine proper course of subsequent care
• Can’t accurately assess quality and effectiveness of services
provided
• Inaccurate views of specific provider quality and efficiency

9. Impact of Duplicates/Overlays on HIEs
*Typically, the larger the data set, the more duplicates and overlays that exist
• Very few HIEs across the country have staff dedicated to measuring the
quality of data coming into the system including the patient identity
• Many HIEs lack data governance policies and those that do have little
power to enforce them
• Data tools used to collect, store, and disseminate information across HIE
don’t have strong record matching algorithms – creates problems of
overlap with patients going to different hospitals and providers
• Often times duplicates aren’t noticed until a provider starts searching
and pulling data from across the network
• Overlays may be detected by providers but if not, significant patient
safety risks may occur
• Many HIEs have greater than a 30% crossover (overlap) duplicate rate
• Overlays and duplicates diminish the ability of HIEs to raise the quality of
care – it decreases their value and the incentives for providers to join

10. • Easier to fix because most patient data software have utilities to allow
staff to merge and/or correct records
Amount of Time Needed to Correct Overlays &
Additional Steps Beyond Clean-Up
Duplicates:
Overlays:
• Time to fix can range from an hour to months depending on complexity
• Depends on EHR system and how easy it is to peel a record apart
• The time the overlay has existed also affects how easy it is to correct
• The number of providers touched by overlays also makes them
complicated to correct
• Staff must comb through note by note and result by result to correct
record
• Beyond correcting the overlay or duplicate, staff must be retrained and
an auditing system created to establish accountability

11. Technologies to Eliminate Duplicates and Overlays
• Record searching algorithms in patient scheduling and registration
systems
• More powerful the algorithm, less likely dups and overlays will be
created
• Success of algorithm dependent on staff training, successful
understanding of how search functions operate, and how to
effectively evaluate & validate results
• Biometrics for patient identification are increasingly used for accurate
patient ID
• Streamlines registration
• Significantly increases patient ID accuracy
• Faster healthcare adopts, faster ROI will be realized
• Studies show that regularly scheduled feedback to patient access staff
with examples of correct and incorrect patient data entries drastically
reduces the creation of duplicates and overlays

12. Hospital Priority on Fixing Duplicates and Overlays
• Greater awareness of duplicate problem at Executive and C-level that
the problem even exists
• Heightened activity in conducting master patient index (MPI) cleanups of
duplicates
• Some EHR/EMR vendors mandate that medical facilities installing their
software report duplicate thresholds before they can go live with
deployment
• Meaningful Use requirements have indirectly spawned more attention
and action to reduce duplicates and overlays
• Less attention at C-level for overlays, often times not recognized until an
adverse event happens
• Since most overlay discovery is anecdotal, it’s unknown how often it
truly occurs - there often isn’t the technology or processes in place to
catch overlays
• Hospitals will start to demand more services and technology that report
patient ID inaccuracies

13. The Value of Establishing a National Patient
Identifier (NPI)
• As healthcare databases increase in size, the chances of duplicates and
overlays increases exponentially
• Increased national attention on the importance of accurate patient
identification will bolster the call for an NPI
• In the absence of an NPI it will be very hard and not cost effective to
perform the level of data exchange created by EHRs and have patients
take ownership and control of their own care
• NPI won’t solve the entire problem – there will always be theft,
inadequate registration training, human error, and historical data errors in
the master patient index (MPI)
• Despite having one, patients may not always remember to bring NPI
when they seek healthcare

14. Thank you to Beth Just for her time and
knowledge for this podcast!

15. John Trader
PR and Marketing Manager
M2SYS Technology
1050 Crown Pointe Pkwy.
Suite 850
Atlanta, GA 30338
jtrader@m2sys.com
770-821-1734
www.m2sys.com
: twitter.com/m2sys
: facebook.com/m2sys
: linkedin.com/company/m2sys-technology
Contact Information