Engaging Stakeholders to Decrease Duplicate Client Records in an EHR

BACKGROUND:   Healthcare information about an individual client that is mistakenly stored in separate, distinct client records can lead to the prescribing of inappropriate medication and the ordering of repeat labs and clinical tests, both of which can ultimately put the client at risk.   Avoiding the creation of duplicate client records in an electronic health record (EHR) system is a critically important step in maintaining good data quality control and avoiding clinical errors. Marion County Health Department (MCHD) maintains a comprehensive health database system allowing multiple health department programs to store client demographic data in a single shared table.  In order to verify that the client record doesn’t already exist, new client registration workflow includes a database search for the client prior to submitting the new client record.  Once entered, duplicate client records can be difficult to discover, especially when clients seek services from multiple health department programs.

METHODS:   We implemented the openEMPI software system to identify current record duplicates in the MCHD healthcare database.  We then organized an EHR stakeholders’ team consisting of database users from multiple MCHD programs.  This team was tasked with designing a process that programs could follow to verify client record duplicates reported by the openEMPI system, and to identify client registration procedures within their program that might have contributed to the creation of duplicate client records.   In addition, the team could recommend the implementation of changes to individual program workflows if they thought these might improve data input.  They could also work with program managers, users and the IT department to assess and modify the program's current user-training.  Finally, the team was to design and help implement a process for the continuing assessment and correction of client record duplication within each program.

RESULTS:   We will present results comparing the percent of duplicate records created before the implementation of the openEMPI system, and the percent created following the stakeholder team's implementation of interventions designed to decrease duplicate client records.

CONCLUSIONS:   The involvement of health department stakeholders in the design of a process to verify duplicate client records and to identify possible workflow problems, gives these stakeholders the opportunity to offer valuable insights that might otherwise not be considered, and that could significantly contribute to the improvement of health department data quality control.