Don't Forget the Providers During Your Spring Data Cleaning

By Julie A. Dooling, MSHI, RHIA, CHDA

The cleanliness, integrity, and trustworthiness of our provider data is essential to remember at all times, even as focus shifts toward other important initiatives, such as working toward a better method of matching and identifying our patients.  When it comes to managing and governing our organization’s information, creating and maintaining accurate, complete, and consistent data is a top priority.  These efforts are certainly no small task, especially in light of healthcare data’s incredible growth.  It is estimated that the US healthcare system will soon reach storing data at the zettabyte (10²¹ gigabytes) level, and—in the not-too-distant future—the yottabyte (10²⁴ gigabytes) level.¹

Healthcare organizations rely on the fact that their information is gleaned from data that is trustworthy.  Our information systems are larger and more interconnected than ever before and maintaining patient and provider data from multiple source systems is a huge challenge.  With the advent of health information exchange (HIE), electronic health records (EHRs), the promise of nationwide interoperability, and recent growth of accountable care organizations (ACOs), databases are connecting and sharing clinical, financial, and operational data with a myriad of stakeholders (i.e., public health, insurance companies, consumers, and providers).

The words “duplicate,” “overlay,” and “overlap” are often used by the health information management professional (HIM) to describe data integrity issues within the enterprise master patient index (EMPI).  Maintaining this critically important database is a key project that ultimately touches every patient on every visit.

In concert to the EMPI is the provider master database.  Maintaining this database (which identifies our providers) must be maintained as well.  Improperly creating and maintaining the identity of our providers can result in discrepancies and duplicate errors such as misidentifying our providers, inefficiencies in the distribution of clinical information leading to problems with continuity of care (i.e., sending patient’s information to the wrong provider or the wrong address), and compliance problems associated with medical staff credentialing.

Name and address changes, practice relocation changes and status changes, such as from “resident” to “attending,” are some examples of data challenges within the provider master database. Best practices include controlling and restricting access when users add providers to limit duplicates and discrepancies, creating a queue to routinely work missing national provider identifiers (NPIs), using sequential numbering ranges to distinguish between various provider categories (i.e.,  anesthesiologist, licensed practical nurse), and the formation of a governing committee that focuses on the overall integrity of the provider master file.

So when you’re doing a little spring cleaning around the organization, don’t forget the providers!

Note

1. Raghupathi, Wullianallur and Viju Raghupathi. “Big data analytics in healthcare: promise and potential.” Health Information Science and Systems. February 7, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341817/.

Julie A. Dooling (jdooling@justassociates.com) is a senior consultant at Just Associates, Inc. With many years of healthcare experience, Dooling has served in various roles including transcription service owner, HIM manager for a large integrated delivery network, and senior sales support for leading document management vendors in the US and Canada.