Medical Insurance describes the intake process using a decision tree model (pg. 79, Figure 3.1, Valerius, Bayes, Newby, & Blochowiak, 2014). The tree leads administration personnel through a list of questions to determine if the patient is a new patient or an established patient.
The first problem with this process is that some of the new patients are patients that have been seen at the practice. If an established patient has an appointment with a new specialist or sub-specialist that patient is registered as a new patient. The problem with this is describing these patients as new patients can lead to multiple patient records and lost data between physicians. If a patient for example, was seen in a large medical office that had several types of specialists and subspecialists creating a new patient chart for each visit to a new doctor or specialist would make it difficult to ensure that all files were updated. This would be particular important for a patient that was under more than one doctors care for more than one problem at a time. In cases where a patient had more than one problem, treatment for problem A could affect the treatment for problem B. It is important for doctors to know a patient’s complete history as well as current care when attempting to treat them.
Using a master patient index is the first step to removing the need for duplicate records. In a master patient index a patient is registered the first time they are seen at a practice and given a constant and unique patient identification number. “Master Patient Index’s ensure that every patient is represented only once, and with constant demographic identification, within all systems of hospital data” (Master Patient Index, 2011). The master patient index as well as the medical records also needs a system to control the circulation of paper files or electronic database.
A centralized medical records office would be the best way to control records (Green & Bowie, 2011). The medical records office would control the master patient index, which is never changed, so if a patient is absent from the practice for a number of years and returns their number could be found in the index. The centralized medical records office would also control the circulation of paper records. To release a record, the office would require a requisition for the record. Then records management would remove the record and replace it with an outcard and log the file back in when it was returned (Green & Bowie, 2011). In an electronic database system, records management would control entering the demographic data and the administration data as well as scanning any paper records into the electronic records (Green & Bowie, 2011).
In a practice where patients might see different specialists or subspecialists there are two options for organizing the patient record. The POR system where each new problem would be entered using the SOAP method: subject (problem), objective (observations of condition and test results), assessment (providers evaluation), and plan (the treatment plan) (Green & Bowie). The second option would be the SOR system where each source (provider, nurse, x-ray technician, lab technician, etc.), would group their entries together (Green & Bowie).
Considering Table 3.1in Medical Insurance the SOR system would probably be the best system for this organization. As this practice is used to organizing files specific to providers this system would be the most similar and thus the least confusing to change to. The SOR system would allow each specialist or subspecialist to easily identify ‘their’ section of the patient record as well as easily reference pertinent information. For instance, a new specialist needs to get lab work done to verify a chemical level before prescribing a particular medication. The specialist can easily access the lab technician’s results and see if the right test has been run recently. In a system where each new visit to a different specialist results in a new patient file, this information would be hard to cross reference.
Maintaining patient records in a centralized location also allows for better control of medical files. When multiple copies of a patient file are in circulation it becomes increasingly difficult to control the circulation and creates unnecessary possibilities for HIPPA violations. A Master Patient Index will also increase efficiency and patient care. According to Building a successful enterprise master patient index: a case study: “there are more overlap patient files than an organization usually perceives; an imprecise and incomplete base of demographic data will multiply the error rate for the enterprise” (Lenson, 1998). The master patient index ensures that patients are given a unique identification number only once, meaning there will never be multiple patient files for one patient. A centralized records management center ensures that there are not duplicate files due to decentralization.
Green, M. A. & Bowie, M. J. (2011). Essentials of health information management: Principles and practices (2nd ed.). Clifton Park, NY: Delmar, Cengage Language Lenson, C. M. (1998, August). Building a successful enterprise master patient index: a case study. Topics in health information management, 19(I), 66-71. http://www.ncbi.nlm.nih.gov/pubmed/10181913 Master Patient Index. (2012). In Search Health IT. Retrieved from http://searchhealthit.techtarget.com/definition/master-patient-index-MPI Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014). Medical insurance: An integrated claims process approach (6th ed.). Boston, MA: McGraw-Hill.
Green, M. A. & Bowie, M. J. (2011). Essentials of health information management: Principles and practices (2nd ed.). Clifton Park, NY: Delmar, Cengage Language