HOW TO - Verify and Merge Duplicate Patient Record Pairs in Epic

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HOW TO - Verify and Merge Duplicate Patient Record Pairs in Epic

  • Occasionally, there will be two patient records in Epic for the same person.  These are automatically flagged by Epic and moved into a "Potential Duplicates" workqueue.  Some of these duplicate patient pairs are, in fact, separate persons (for example, twins that have the same birth date and last name).  This article will direct you on how to verify that a flagged patient pair is in fact a duplicate, and, once verified, how to properly merge the records.

 

General Information

Where do duplicate patient records come from?

Duplicate patient records typically come from a new Service Area (SA) build, or during Registration.

  • New Service Area build
    • Patient information is imported from the old Electronic Medical Record (EMR) software and imported into OCHIN Epic
    • If that patient already exists in OCHIN Epic (i.e. they've been to another clinic that also uses OCHIN Epic and they have a patient record there), this makes a duplicate record
  • Registration
    • When a patient checks in at the clinic, the front desk staff should be verifying that the patient doesn't already have a record
      • They may be typing in the patient's full name rather than using the "3-comma-3" method
        • 3 letters for the last name, 3 letters for the first name (separated by a comma)
        • Using the "3-comma-3" method can prevent errors such as spelling mistakes, and is more likely to result in finding the correct patient
      • OCHIN also recommends to clear the Service Area field when performing a patient search
        • This will ensure that, if the patient has been seen at another OCHIN Epic clinic, you'll find their record
    • If the patient has a record at another OCHIN Epic clinic (or their name was misspelled during patient search) and a new record is created for them anyway, this creates a duplicate patient pair
      • There is a method for importing patient records from another clinic called "Break the Glass" or "BTG."  More information can be found in the Patient Lookup and Break the Glass article on Ella, the Epic resource website.

Why merge duplicate patient records?

There are a number of reasons you only want one record for each individual patient in the system, including:

  • It simplifies patient lookup by reducing the overall number of patients
  • It reduces errors in patient lookup
  • It improves patient safety
    • Multiple records mean incomplete information in one or more charts
      • For example, a patient could have allergy information in one chart but not in the other
  • It reduces billing errors and keeps all charges on one account

How can I gain access to merge duplicate patient pairs?

OCHIN limits the amount of users that have the ability to merge duplicate patient pairs.  This is because, if a patient pair is merged that turns out to not be a duplicate, it's quite a difficult process to unmerge that pair (more information below).


To request access, please send an email to epicsupport@westernu.edu, and copy your direct supervisor on the message.  Once your supervisor approves, a JIRA (help ticket with OCHIN) will be opened to give you access to the course on Ella (the OCHIN Epic training website) called "Site Specialist Foundations: Patient Merge."

 

The Ella training course consists of a video that's approximately 80 minutes long, followed by a quiz that must be passed with a score of 80% or higher within four attempts.  While this article is not a replacement for the training video, it can be used as a quick reference for the key points in merging duplicate patient pairs.

I read this article, but I still need help with the merge process.

If you need technical assistance with the merge process, please click here to submit a ticket.
Steps for Merging

Identify potential duplicate patient pairs

When a patient pair is flagged as a duplicate, it's automatically moved into a Potential Duplicates Workqueue in Epic.  There are a number of factors that lead to a patient pair being flagged as a duplicate, including identical name, sex or DOB.  There are two Potential Duplicates Workqueues for WesternU (ID 9571 and 11256). 

 

Once you watch the video and pass the quiz on the Ella Patient Merge course, a JIRA will need to be opened to grant you permission to view the workqueues.  Please email epicsupport@westernu.edu once you've passed your quiz, and the JIRA will be opened for you.

Review patient information to confirm the pair of records are actually duplicates

As mentioned earlier, it is a difficult process to un-merge a patient pair once it has been merged.  Therefore, it's crucial to investigate and confirm that the pair of records are actually duplicates.  You can verify this by checking for identical information in the following places:

  • Registration
    • Demographics
      • Age, sex, DOB, ethnicity, language preferences etc.
    • Emergency Contact
    • Scanned Documents
      • Generally includes patient signature; you can check if the signatures are identical
    • Coverages (insurance)
  • Chart Review
    • Both patient records show the patient is diabetic, has the same chronic illness, is taking birth control pills etc.

 

Another helpful tool in confirming duplicate patient records is the Identity Manager, found in:  Epic > Tools > Identity Tools > Manage Patient Identity

  • Patient Lookup
    • Use the "3-comma-3" search method (as mentioned earlier in this article) in the "Name/MRN" box to search for the first potential duplicate patient in your pair
    • Follow the same path to "Manage Patient Identity" and search for the second potential duplicate patient in your pair
  • Once you have both patients open in Identity Manager, under the Overview tab, you can easily view at a glance each patient's DOB, sex, address, preferred aliases etc.

 

If you have verified that the suspected duplicate pair is in fact not the same patient, you can mark them as "Known Non-Duplicates."

  • In Identity Manager, click on the "Known Non-Duplicates" tab
  • Click the "New Known Non-Duplicate" button
  • Select the second patient in the "Open Patients" list
  • On the window that pops up asking "Would you like to activate this Known Non-Duplicate?", select "Activate"

  • Back in Identity Manager, you can confirm under the Identity Manager Overview tab that the other patient's name is now listed under "Known Non-Duplicates"
  • At this point, the pair has been removed from the Potential Duplicates workqueue

Review and resolve all pre-merge checks

If it is determined that one patient does have a duplicate record, the following points need to be checked before submitting the merge request:

  • Marked as Known Non-Duplicates
    • If the records have been marked as Known Non Duplicates, but you're certain this was in error, you can clear this in Identity Manager
  • Appointments scheduled at the same time
    • You will need to cancel one of the identical appointments
  • Two active MyChart accounts
    • One of the accounts must be deactivated
  • Two active Medicaid/insurance coverages
    • One coverage must be deactivated
  • Care Everywhere links
    • Unfortunately, there isn't a way to check this prior to the merge attempt
      • This is something only OCHIN can view/resolve
    • If all of the above points have been cleared, go ahead and attempt the merge
      • If the merge fails due to a duplicate Care Everywhere link, an error message will state this
    • If the merge fails due to this point, email epicsupport@westernu.edu and a JIRA will be created

If any of the above points are not resolved prior to attempting the merge, the merge will fail.

Determine Target and Source Patient

  • Target Patient
    • This is the record that will remain after the merge is complete
    • The patient with the most historical data is usually the Target Patient
    • This record usually will have been created before the Source Patient record was created
  • Source Patient
    • This is the record that will be removed from Epic during the merge
    • The record with a later creation date is usually the Source Patient
    • Information from this record will be copied into the Target Patient record

 

To determine which patient record is the Target Patient (the record that was created first): 

  • Open the Identity Manager, found in:  Epic > Tools > Identity Tools > Manage Patient Identity
    • Open up both patient records
    • Click on the "Identifiers" tab
    • Under the MPI History section, look for the "ENTERPRISE ID NUMBER"
      • The "Action Date" is the date the patient record was created

  • The record with the earlier creation date is usually the Target Patient

Access Patient Merge under Epic > Tools > Identity Tools > Patient Merge

  • Select the Source Patient first, then the Target Patient
  • The Patient Merge window will then open, showing the Source Patient, Target Patient, and Merge Result

  • The fields that will appear in the Merge Result are highlighted in blue under Source Patient/Target Patient
    • To change the fields that will appear in the Merge Result, click on the field in the other column
      • ​​​​​​​It will then be selected in blue, and the change will be reflected under Merge Result

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  • Once everything looks good, click Merge
  • You will see one last confirmation window - click Merge again to complete the merge

 

​​​​​​​When a merge occurs, Epic takes a snapshot of the pre-merged data for each record.  This can be viewed under the Overview tab in Identity Manager.
What to Do If a Merge Fails/Was Incorrectly Merged

Unmerging incorrectly merged records

  • ​​​​​​​Unmerging records can take an extended amount of time - potentially up to six months
  • Unmerging an incorrectly merged record must be done by OCHIN staff​​​​​​​
    • If discovered that two patient records were incorrectly merged, a JIRA needs to be submitted to have them unmerged
    • Please email epicsupport@westernu.edu so a JIRA can be opened

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Once the unmerge has been completed by OCHIN, it is the responsibility of the clinic that performed the incorrect merge to restore all of the information to the correct patient records, and to resolve any other issues that may have occurred.

Merge failed due to a pre-merge check or other unknown reason

  • Only OCHIN staff can resubmit failed merges
    • ​​​​​​​A JIRA must be filled out for this request
    • Please email epicsupport@westernu.edu so a JIRA can be opened
  • OCHIN staff must also perform merges on duplicate patient records where each one is in a different Service Area
    • You can only merge duplicate patient records where both exist within WesternU
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