patients for each facility in the RHIO, the number of linkages established across facilities, the number of duplicates generated by each facility, and the number of duplicates adjudicated.
Working through the Issues along the Way
Even though the HIM committee continues to provide input into
the development of the Bronx RHIO, the process of exchanging
information will never be easy… or predictable. For example,
one of the facilities in the RHIO treated brothers named Steven
and Stephen born one year apart.
“Their medical records are so inexorably intertwined that I
don’t know that anybody will ever separate them. But the RHIO
helped identify the problem and sensitize the source facility.
Going forward their charts are likely to be kept straight,” Shatzkin says.
The ability to match a baby’s birth record with their named record presents another challenge. Each facility may have its own
policy on updating birth records with the official name. This occurs when the birth record at one facility says “Baby Boy [insert
last name],” and the ongoing record at another facility actually
includes a name.
“We had to develop policies around that and work with different organizations to improve their methods of assigning real
names to babies after they were named,” Greaves says.
There are also policy-related challenges, and the RHIO’s policies must be flexible to adapt to new information, Greaves says.
For example, in an initial policy, Medicaid ID numbers were
used to distinguish between patients. The HIM committee subsequently discovered that this cannot be applied to patients
younger than one year old because Medicaid temporarily assigns the mother’s number to the baby. As a result, the committee had to update its policies to reflect this reality.
There are financial challenges as well. “Resources are a huge
challenge for many HIM departments,” Greaves says. “Different
facilities staff differently and have different resources. Some-
times we know what to do and how to fix something, but the
resources are just not there to do what has to be done.”
The sooner HIM professionals can get involved in their state’s
RHIO or HIE, the better, Shatzkin says. “It really makes sense
to have HIM professionals engaged in the process from the be-
ginning as policies are being developed, as software is being
configured and tested, and as operational workflows are being
developed,” she adds.
Greaves encourages her colleagues to contact their HIE and
find a way to get involved. Articulate some of the challenges inherent in managing patient identity so that the key stakeholders
become aware of these issues, she recommends. Consider partnering with HIM directors from other facilities participating in
the HIE to approach the HIE board of directors as a group. “Do
what it takes to be at the table!” Greaves says. ¢
Lisa A. Eramo ( leramo@hotmail.com) is a freelance writer and editor in
Cranston, RI, who specializes in healthcare regulatory topics, health information management, and medical coding.
