Keeping duplicates at bay without depleting internal resources

Sept. 14, 2018
Beth Haenke Just
CEO and President,
Just Associates

Despite unprecedented attention on multiple levels, duplicate records continue plaguing healthcare organizations. The average electronic master patient index (EMPI) system has a duplicate rate of 8%-12%—the equivalent of 80,000-120,000 duplicate records for a hospital system serving 1 million patients, each costing the facility approximately $96.1

An intractable problem

That was the finding of a study conducted at Children’s Medical Center Dallas, which also found that clinical care was negatively affected in 4% of cases involving confirmed duplicate records. The most common issues were treatment delays, duplicate tests due to lack of access to previous results, and surgical delays due to lack of access to patient history and physical reports—all of which added approximately $1,100 to the cost of care.2

Despite well-established best practices designed to prevent the creation of duplicates, ranging from deployment of probabilistic and/or rules-based algorithms to stakeholder education, the problem persists. Indeed, not only are duplicate records an intractable challenge, but their impact has grown exponentially with the popularity of data sharing across and between organizations. Today, a single duplicate can rapidly contaminate multiple systems within the originating facility and any facility with which it exchanges information.

Courtesy of Just Associates

While many healthcare organizations have had little luck lowering their duplicate rates, it is not from lack of trying. Many have undertaken at least one large-scale EMPI clean-up to eradicate any existing duplicates. But the proliferation of health information exchange is increasing the volume of information flowing into EMPIs exponentially; data that often does not adhere to the same standards as are in place at the receiving organization. The result is recontamination with yet more duplicates.

As the duplicate rate climbs, so too does the level of resources required to keep systems clean. A survey by the College of Healthcare Information Management Executives (CHIME) found that respondents typically had at least two people dedicated to “data cleansing,” which includes reconciling duplicates. It’s a luxury that is out of reach for most healthcare organizations.3

Enter post-cleanup outsourcing

Faced with the prospect of paying for repeated cleanups or getting swamped with duplicates, a growing number of hospitals are seeking out MPI support services that leverage both technology and expertise to provide ongoing EMPI monitoring and management. These services rapidly identify, validate and reconcile duplicate records before they can infiltrate and contaminate downstream and outside systems, maintaining the integrity of the EMPI without draining internal resources—often at savings as high as 40%.

This was the action taken by Jefferson Radiology to maintain the integrity of the approximately 1 million records flowing through its EMPI each year. Recognizing its limited resources and lack of specific expertise could do more harm than good, the practice outsourced the ongoing management of its EMPI to Just Associates and IDManage, its MPI support solution. Doing so enabled Jefferson to keep its staff focused on its core competencies, and also provided access to technology, third-party data and other resources capable of delivering a higher rate of accuracy that it would otherwise have achieved.
More importantly, by bringing in MPI and data integrity experts to act as quality control, outsourcing prevented Jefferson from relying too heavily on technology. Often viewed as a magic button when it comes to eradicating duplicates, technology must be used prudently, or it can leave even the most well-intentioned facilities drowning in both duplicates and their costlier and more dangerous counterpart, overlays.

For Jefferson, bringing in MPI support services has helped it maintain a duplicate rate well below 1%. The few duplicates that do trickle into the system are identified, validated and resolved within 24 hours, greatly reducing the potential for compromising patient safety and care.

Concludes Jefferson CTO Michael Quinn, “It takes a lot of resources to maintain MPI data integrity. We simply don’t have the staff, expertise or ability to do it ourselves. The real value is that they make it possible for our staff to focus on core competencies because their consultants are focusing on working through identity issues. In healthcare, that’s very important.”


  1. Haenke Just B, Marc D, Munns M, Sandefer R. Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields. Perspectives in Health Information Management. Spring 2016. Available at
    Haenke Just, et al.
  2. College of Healthcare Information Management Executives. Summary of CHIME Survey on Patient Data. Press Release. May 16, 2012. Available at

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