Developing a Strategy to Win the War on Duplicates

Developing a Strategy to Win the War on Duplicates

This monthly column will discuss all the components of quality clinical documentation with a comprehensive approach to cover all areas of the healthcare industry.

By Robin E. Gates, RHIA


Duplicate records remain one of healthcare’s most vexing—and costly—problems. Consider that the average master patient index (MPI) system has a duplicate rate of between 8 percent and 12 percent—the equivalent of 80,000 to 120,000 duplicate records for a hospital system serving 1 million patients. Each pair of duplicate records costs the facility approximately $96 to resolve. (Some say the average rate is even higher, with Black Book Market Research putting it at 18 percent in its 2018 Mid-Year EHR Consumer Satisfaction Report.)

On top of that, there are significant clinical costs associated with duplicates. At one major pediatric facility, clinical care was negatively affected in 4 percent 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 because of a lack of access to patient history and physical reports—all of which added approximately $1,100 to the cost of care for each impacted patient.

All of this is happening despite efforts to address the issue at national and individual facility levels—and despite well-established best practices designed to prevent the creation of duplicates. In fact, not only are duplicate records an intractable challenge, but their impact has grown exponentially with the proliferation of health information exchange. Now, a single duplicate can quickly contaminate the systems at the originating hospital and any facility on the receiving end.

As the duplicate rate climbs, so too does the level of resources required to keep systems clean. For most hospitals, dedicating the staff required to identify and reconcile duplicates before they are able to run amok within the EMPI and other systems is a luxury that is simply out of reach.

It’s time to consider a new strategy.

Faced with the prospect of paying for repeated cleanups or getting swamped with duplicates, some hospitals are seeking out support services that leverage both technology and expertise to provide ongoing EMPI monitoring and management. These services are charged with the task to 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.

For some providers, outsourcing MPI maintenance could indeed be an effective solution. For example, a radiology center with about 1 million records flowing through its MPI each year reporteds a duplicate rate well below 1 percent after outsourcing its MPI support services. And duplicates that do make their way in are typically identified and resolved within one day.

In short, outsourcing ongoing MPI maintenance has the potential to reduce costs and increase productivity within the health information management department. What’s more, outsourcing can help reduce the clinical costs and patient safety issues incurred due to duplicate records, helping ensure quality of care and a stronger bottom line.

What is your facility’s current approach for dealing with duplicate records? Have you considered outsourcing? Let us know in the comments below.


Robin E. Gates, RHIA, ( is vice president sales for Just Associates.

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  1. Very well articulated by Robin Gates and so very pleased that AHIMA is re-posting the subject of Patient Matching.
    This needs to be a consistently monitored issue in health facilities, and in some occasions I am surprised as a hospital surveyor when it is not targeteted on HIM Dashboards, in conjunction with efficient/effective corrective action plans to address a persistent concern in the industry.
    The impact to interoperability and HIE is significant.

  2. Great Article. The integrity of the Health Record begins in Patient Access. Thank you for the valued information

    1. In Northern CA at our clinics, we have a lot of duplicate records. It’s my job to find such errors and merge the two records. I find that most are data entry errors. While a majority of duplicates are created because of bogus information given by the actual patient. Most patients in our area are low income and feel that if they can dodge the old bill, they will give a bogus DOB. Thus the duplicate account is created by no fault of our employees. We are a hybrid EMR system with electronic medical records and paper charts. We have 3 systems, 2 previously used before the implementation of EHR. We are also custodians of 4 local medical centers that have closed up shop in years past. Thus, we have those additional paper charts sitting in our warehouse. I also scan the paper charts to integrate into the Electronic chart. We have implemented a system of checks and balances. We use a license, Social Security data base (Lexis Nexis, which is not always correct.), information within the paper charts and basic detective work. Sometimes the patient is key to match up previous charts. But more often than not, we are bound by privacy issues and a lack of information. This is not an easy task by any means. On average, between all 4 clinics, we are around 8%-25% duplicate rate. It varies by location and size of patient population. Though once we were able to sign on for a government Social Security data base, it’s been a little easier. But you need a social security number for that data base to work. Some of our patients do not have a SS#. Then we have to rely on a license, ID or the correct information given by the patient.

      I’ve become quite the expert out of necessity to find a match to the old paper chart. I’ve gone so far as to match a paper record to a patient via signatures and family members. We have over 80,000 paper charts in a warehouse and it’s my job to find matches.

      Duplicates can have catastrophic results to a patient’s care. I believe a patient should be aware of the consequences of having a duplicate medical record. Sourcing these jobs out to employees that are off site is a burden on smaller clinics, cost wise and familiarity with older systems previously in place. I’m very lucky to have a clinic that sees the need and I think because of this dedication to our patients, we have one of the most complete electronic records in the area, if not the state.

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