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Self-Scheduling and COVID-19: Necessity Adds to Health Care’s Patient Matching Woes

By Karen Proffitt, MHIIM, RHIA, CHP

The explosive popularity of telehealth to ensure ongoing access to care as COVID-19 ravages the nation brings with it an equally rapid rise in patient self-scheduling—an upward trajectory accelerated by the need for streamlined methods of scheduling vaccinations.

Born of necessity, self-scheduling has nonetheless added to the already dismal state of patient matching. Desperate for appointments, many patients inadvertently create multiple medical record numbers as they work through the schedule system, wreaking havoc on health care organizations’ electronic master patient index (EMPI) and EHR systems, as well as the ongoing quest for a 1% or lower duplication rate.

An excellent example of the self-scheduling boom can be found in the massive popularity of a patient portal-based COVID-19 self-triage and self-scheduling tool created in February 2020 by University of California, San Francisco (UCSF) Health for use by primary care patients at UCSF Health. In a study published in the Journal of the American Medical Informatics Association, UCSF Health researchers reported that, during the first 16 days of use, the tool was accessed 1,327 times and completed 1,129 times by 950 unique patients. Furthermore, 29 patients—56% of patients placed in the nonurgent disposition category following self-triage—directly scheduled video visits in the 10 days during which video visit direct scheduling was active. And they did so far faster than patients who called the system’s hotline to schedule visits.

Given the newfound popularity of telehealth and virtual visits, it is unlikely the volume of patients utilizing self-scheduling options will taper off anytime soon. In “2020 Virtual Care Forecast, US,” released in October 2020, Forrester estimates that virtual visits for general medical care will exceed 440 million in 2021, while HIMSS reports that 77% of the more than 2,000 patients surveyed are willing to use some form of telehealth postpandemic and 41% cite it as their preference in specific circumstances.

These findings are in line with an earlier survey by GetApp, in which nearly 70% of respondents said they’d choose to book online if a variety of booking options were available, compared with only 20% who would choose to book by phone. Additionally, when asked about the biggest pain points related to scheduling appointments, more than 56% of respondents cited the inconveniences of booking by phone, including too much time wasted on hold and too few options.

Double-Edged Sword
For provider organizations, self-scheduling has become a double-edged sword, particularly with the rapid uptake in use by patients who aren’t experienced in how to properly search for their existing medical records. While it checks the boxes of increased patient satisfaction, lower call volume, and fewer resources dedicated to scheduling, it is exacerbating one of health care’s most intractable problems: duplicate and overlaid medical records that lead to patient matching and identification issues.

A growing number of hospitals and health systems are sharing their self-scheduling horror stories as demand for telehealth and COVID-19 vaccination appointments leads to sizeable bumps in duplicate records—despite their best efforts at patient education. One West Coast health system hoped that requiring patients to schedule appointments for COVID-19 vaccinations via the PHR integrated with its EHR would streamline the process for everyone. However, the system still created new (often multiple) records whenever the patient’s existing record could not be located. With upwards of 6,500 vaccination appointments each day, the surge in duplicates and overlays in their EHR’s identity queues was massive—creating additional problems when affected patients tried to schedule their second vaccination.

A health system in the Pacific Northwest teamed up with several other organizations with the goal of vaccinating tens of thousands of patients per day. After several days, however, its EMPI had amassed several thousand potential duplicates requiring remediation before they impacted downstream systems. Another hospital was forced to pause self-scheduling, which it had hoped would speed registration for vaccinations, after a surge of duplicates overwhelmed the system. The option remained offline until the HIM department could clean up the mess and implement new procedures to avoid another overload.

Several other health care organizations are setting up independent EMPIs for self-registration around COVID-19 tests and vaccinations. They understand, however, that doing so will only delay the inevitable. Duplicates will most certainly be created when those records are ultimately merged with their main EMPI and integrated into patients’ official records.

A Grim Outlook
Standalone EMPIs and halting self-scheduling are just temporary patches to a long-term problem. Now that they have had a taste of the ease and convenience self-scheduling has to offer, patients are demanding access. Unless real solutions are found to the patient identification issues exacerbated by the unintended consequences of self-scheduling, an already significant problem will only get worse.

Already, inaccurate patient identification costs the average health care facility $1.2 million per year and contributes to everything from denied claims and adverse events to duplicate testing and delays in diagnosis and treatment. Furthermore, about 18% of patient records are duplicates and approximately 1 in 5 is incomplete, including an estimated 40% of demographic data missing from commercial laboratory test feeds for COVID-19.

This means the huge uptick in duplicates is not just an internal problem for a hospital or clinic; it has the very real potential to hamper efforts to gain control over the pandemic. Contact tracers rely on accurate and comprehensive information to locate patients. Public health agencies rely on consistent, reliable, and reproducible data for reporting. A widespread and safe vaccination program requires a consistent and accurate means of identifying individuals.

Thus, as the nation’s response to the COVID-19 pandemic continues to lay bare the plethora of patient matching and identification challenges confronting health care, it is imperative that we take a deep—and realistic—dive into the possible solutions. Everything from a national patient identifier to United States Postal Service (USPS) address formatting tools and stronger matching algorithms has been put on the table, and all have their merits. However, there is no magic bullet, no one-size-fits-all solution.

The Path Forward
Internally, health care organizations can take a few immediate steps to chip away at their duplicate rates. The first is to conduct an MPI cleanup to deal with existing duplicates, overlays, and shell records. To keep the cycle from repeating, several hospitals and health systems are turning to MPI remediation services that provide ongoing EMPI/EHR 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/EHR without draining internal resources.

Additional actions include the following:

• increasing patient education around proper use of self-scheduling tools;
• auditing standards in conjunction with Patient Access to determine what policies are in place to ensure the MPI remains clean;
• training employees on the standards;
• conducting ongoing quality assurance to identify problem areas and intervene with education and training when necessary; and
• leveraging existing tools, including the USPS address-formatting tool, to help standardize data as much as possible in lieu of national guidelines.

At the industry and national levels, the cure will include continued pressure to remove obstacles standing in the way of a national patient identifier, along with industrywide standardization, third-party data, and expert analysis and intervention.

Until duplicates can be stopped in their tracks, the full benefits of self-scheduling, telehealth, and other patient-centric tools to help ensure access to care during and after the pandemic will remain just beyond our grasp. Truly moving the needle on eliminating duplicate and incomplete patient records requires a multifaceted solution that brings together USPS tools, third-party data, expert analysis and intervention, and industrywide standardization.

— Karen Proffitt, MHIIM, RHIA, CHP, is vice president of data integrity solutions for Just Associates, Inc, a nationally recognized leader in patient matching and health information data integrity and management.