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RPMS Patient Merge Training

November 2011

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Agenda

• Why are we doing Patient Merge?• Process and terminology overview• Software walk-through• Other processes• Beta site experience• Next steps

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Have you ever seen this:

Select Patient Name: Smith, Joseph P

1 Smith, Joseph P 666-99-2233 4/4/78

2 Smith, Joseph P 666-99-2223 4/4/78

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Or this? …searching for potential duplicates...

The following patients have been identified as potential duplicates:

TESTER,JO 8-1-45 666232333

Do you still want to add 'TESTER,JO B' as a new patient? No// Y

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Why Patient Merge?

• Combine patients who are enrolled multiple times

• Providers will see all patient’s data for that facility

• Requirement for national MPI (Master Patient Index) implementation

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Basic Merge Process

• Three major steps in the process:Search

Review/Verify

Approve/Merge• Two users• There is no Unmerge!

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Overall ProcessMergeReview and VerifySearch

Pat

ient

Mer

geA

pplic

atio

n S1/SRCHSearch for Potential

Duplicates

S1/PRNTPrint a List of

Duplicates

S2/VPDVerify

Duplicates

S3/AVDApprove

Duplicates

S3/SCHSchedule

Merge Process

Research Potential

Duplicates

Update paper chartsE

xter

nal

Pro

cess

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Accessing the Application

********************************** -----> INDIAN HEALTH SERVICE

IHS PATIENT MERGE -----> -----> VERSION 1.0

********************************** YOUR FACILITY’S NAME

S1 Find Potential Duplicates ... S2 Review/Verify Duplicates ... S3 Merge Verified Duplicates ... PMR Patient Merge Reports ... DMU Duplicate Manager Utilities ...

Select IHS Patient Merge Option: S1

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Searching for Potential Duplicates

Select IHS Patient Merge Option: S1 Find Potential Duplicates (Your facility’s name)

SRCH Start/Halt Duplicate Search DSS Display Search Status FIND Find Potential Duplicates for an Entry in a File CHCK Check Pair of Records to see if Duplicates PRNT Print List of File Duplicates VIEW View Duplicate Record Entries

Select Find Potential Duplicates Option: SRCH

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Starting the SearchSelect IHS Patient Merge Option: S1

Select Find Potential Duplicates Option: SRCH

Duplicate VA PATIENT Search

Search Type Date Completed Status hours:min # Records Checked----------- ------------------ --------- --------- -----------------BASIC DEC 28, 2006@16:08 COMPLETED 3:02 26133/26133 100.0%

216 Potential Duplicate pairs added to the DUPLICATE RECORD FILE (#15) Do You wish to RUN a search (Y/N)? YESWhich type of Search do you wish to run ? (BASIC/NEW) BASIC// BASIC

This process will take a **LONG** time (known to exceed 100 hours),but you CAN stop and restart the process when you want usingthe options OK? YES

Requested Start Time: NOW// T@8:00PM

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Section 4.1

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Display Search StatusSelect IHS Patient Merge Option: S1

Select Find Potential Duplicates Option: DSS

Duplicate VA PATIENT Search

Search Type Date Started Status hours:min # Records Checked----------- ------------------ --------- --------- -----------------BASIC JAN 4, 2007@08:17 RUNNING 0:12 545/26133 2.0%

6 Potential Duplicate pairs found

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Section 4.2

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Print Duplicate ListSelect IHS Patient Merge Option: S1

Select Find Potential Duplicates Option: PRNT

Select one of the following: 1 BRIEF 2 CAPTIONED

Choose type of list: 1 BRIEF

This utility provides reports on verified and unverified potential duplicates.

Select one of the following: 1 UNVERIFIED potential duplicates 2 NOT READY TO MERGE VERIFIED duplicates 3 READY TO MERGE VERIFIED duplicates 4 MERGED VERIFIED duplicates

report: 1 UNVERIFIED potential duplicatesDEVICE: HOME RIGHT MARGIN: 80// <ENTER>

...EXCUSE ME, LET ME THINK ABOUT THAT A MOMENT...

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Section 4.5

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Print Duplicate List - Brief1

Unverified Potential Duplicates MAY 19,2009 13:33 PAGE 1----------------------------------------------------------------------------

IEN: 27 RECORD 1: PATIENT,ONE [IEN: 3743] SSN: 234350987 HRCN: 5848 RECORD 2: PATIENT,ONE [IEN: 3750] SSN: HRCN: STATUS: POTENTIAL DUPLICATE, UNVERIFIED SCORE %: 100

IEN: 37 RECORD 1: PATIENT,FIVE [IEN: 4496] SSN: HRCN: RECORD 2: PATIENT,FIVE [IEN: 7803] SSN: 121212121 HRCN: 12718 STATUS: POTENTIAL DUPLICATE, UNVERIFIED SCORE %: 100

IEN: 44 RECORD 1: DEMO,PATIENT [IEN: 5166] SSN: 123456789 HRCN: 8656 RECORD 2: DEMO,PATIENT JR [IEN: 23661] SSN: 123456789 HRCN: 8656 (I) STATUS: POTENTIAL DUPLICATE, UNVERIFIED SCORE %: 95

IEN: 45

Section 4.5

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Print Duplicate List - Captioned1

Unverified Potential Duplicates MAY 19,2009 13:35 PAGE 1----------------------------------------------------------------------------

RECORD1: PATIENT,ONE RECORD2: PATIENT,ONESTATUS: POTENTIAL DUPLICATE, UNVERIFIED DATE FOUND: DEC 28, 2006 WHO CREATED: USER, PM DC TOTAL POSSIBLE SCORE: 235 DC POTENTIAL DUPE THRESHOLD %: 60 DC DUPE MATCH SCORE: 230 DC DUPE MATCH PERCENTILE: 98DUPLICATE TEST: NAME DUPLICATE SCORE: 100DUPLICATE TEST: SSN DUPLICATE SCORE: 0DUPLICATE TEST: TRIBE OF MEMBERSHIP DUPLICATE SCORE: 5DUPLICATE TEST: SEX DUPLICATE SCORE: 20DUPLICATE TEST: DATE OF BIRTH DUPLICATE SCORE: 60DUPLICATE TEST: DATE OF DEATH DUPLICATE SCORE: 0DUPLICATE TEST: MOTHER'S MAIDEN NAME DUPLICATE SCORE: 50DUPLICATE TEST: LAST SEPARATION DATE DUPLICATE SCORE: 0DUPLICATE TEST: CLAIM NUMBER DUPLICATE SCORE: 0

Section 4.5

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Review Duplicates

• Examine data for the potential duplicates– RPMS– Charts

• Retrieve old charts from archives if applicable• Contact specialties• Contact patient• Contact other service units

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Review and verify duplicates

Select IHS Patient Merge Option: S2

Review/Verify Duplicates(Your facility’s name)

PMP Identify Potential Merge Problems VPD Verify Potential Duplicates ADD Add Verified Duplicate Pair CDC Check for Data Conflicts DVP Display Verified Pair EDIT Edit the Status Field of a Duplicate Record

Select Review/Verify Duplicates Option:

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Verify Potential Duplicates

Select Review/Verify Duplicates Option: VPD

At the following prompt select a POTENTIAL DUPLICATE ENTRY. If a selectionis not made, you will be given a chance to select from a list if youwant to. Otherwise, you will be returned to the menu system.

Select VA PATIENT NAME: <ENTER>Do you want to select from a list of potential duplicates? YES// <ENTER> 1. PATIENT,DEMO A^M^2000712^^8^^^^000043577^^CHEROKEE^34 PATIENT,DEMO B^M^2000712^^8^2^^^000943666^^CHEROKEE^34 2. PATIENT,ONE Z^M^2001108^^^^^^000942180^^CHEROKEE^34^^^^^^^^1 PATIENT,ONE^M^2001108^^^^^^^^^^^^^^^^^1

Enter Return to continue listing or

Select the desired entry by number: (1-2): 1

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Section 5.1

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Verify Potential DuplicatesDetermine if these patients ARE or ARE NOT duplicates.

RECORD1 [#1212] RECORD2 [#888]PATIENT,DEMO A PATIENT, DEMO BCMOR SCORE=NULL CMOR SCORE=NULL

----------------------------------------------------------------------**** NAME "PATIENT,DEMO A" "PATIENT,DEMO B" SEX MALE MALE**** DATE OF BIRTH 06/28/51 06/29/51 MARITAL STATUS DIVORCED DIVORCED RACE AMERICAN INDIAN OR

ALASKA NATIVE(List shortened for display.)

Enter RETURN to continue or '^' to exit: ^

Select one of the following: V VERIFIED DUPLICATE N VERIFIED, NOT A DUPLICATE U UNABLE TO DETERMINE H HEALTH SUMMARY R REVIEW DATA AGAINSelect Action: HEALTH SUMMARY// V

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Section 5.1

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Select Merge Direction

Select Action: HEALTH SUMMARY // V VERIFIED DUPLICATE

RECORD1 [#1212] RECORD2 [#888]PATIENT,ONE PATIENT,ONE A

Select one of the following: 1 RECORD1 INTO RECORD22 RECORD2 INTO RECORD1

Which record (1 or 2) should be MERGED INTO the other record: RECORD1 INTO RECORD2// 1

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Section 5.1.2.1

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Determine Overwrites

PATIENT,ONE PATIENT,ONE A---------------------------------------------------------------**** NAME "PATIENT,ONE" "PATIENT,ONE A"**** DATE OF BIRTH 06/29/00 06/28/00**** SSN "000060969" "000060996"**** ZIP CODE "00093" "0004"

1 NAME2 DATE OF BIRTH3 SOCIAL SECURITY NUMBER4 ZIP CODE

OVERWRITE data for selected fields: (1-4):1,3

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Section 5.1.2.2

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Approve duplicatesSelect IHS Patient Merge Option: S3

Merge Verified Duplicates(Your facility’s name)

AVD Approve verified duplicates for merging SCH Schedule Process to Merge Verified Duplicates CMP Check Merge Process Status (reverse order) SMP STOP an Active Merge Process RMP Restart a Merge Process HSV Health Summaries for Verified or Merged Pairs

Select Merge Verified Duplicates Option:

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Approve merge pairsSelect IHS Patient Merge Option: S3Select Merge Verified Duplicates Option: AVD

4 Entries are awaiting approval for merging Return to continue... <ENTER> 1 PATIENT,FIVE 000-02-7082 [121212] #23457 PATIENT,FIVE Z 000-02-7082 [6543] #7881 2 PATIENT,SIX A 000-02-8495 [123456] #11445 PATIENT,SIX B 000-02-4895 [787878] #12234 3 PATIENT,THREE Z 000-04-5972 [999699] #113441 PATIENT,THREE X 000-04-5972 [098765] #112777 4 PATIENT,DEMO 000-04-6995 [123234] #109003 PATIENT,DEMO JR. 000-04-6995 [232323] #100871Select entries to approve them for merging: (1-4): 1

• Verify the first user’s research to determine which pairs to approve

• Remember, THERE IS NO UNMERGE!

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Section 6.1

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User 2

Merged Patient

Last Name: TesterFirst Name: John

SSN: 132-45-6789Sex: M

Mother’s Maiden Name: JonesDOB: 4/4/1960

DOD: Tribe: Cherokee

Lab Results

Test Results

Pharmacy Records

Medical Record

Lab Results

Test Results

Medical Record

Merge3

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Schedule a MergeSelect IHS Patient Merge Option: S3Select Merge Verified Duplicates Option: SCH

1 Entries Ready to be included in merge

This process will take a **LONG** time (usually over 15 hours, and sometimes considerably longer), but you CAN stop and restart the process when you want using the options. OK? YES

Name for Merge Process: SMITH-20090606

START DATE/TIME: NOW

Merge process ‘SMITH-20090606' for Verified Duplicates in File 2 scheduled.

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Section 6.2

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Checking Merge StatusSelect IHS Patient Merge Option: S3Select Merge Verified Duplicates Option: CMP

Current CurrentMerge Set Start Stat Last Chk Phase File Entry

MERGE 1 09/30 17:21 C 09/30 22:14 DATA CHECKING 09/30 17:21 C 09/30 17:21 IHS PATIENT MER 09/30 17:21 C 09/30 17:21 VA PATIENT FILE 09/30 17:21 C 09/30 21:50 THREAD 2 C 09/30 22:14 THREAD 3 C 09/30 21:12 THREAD 4 C 09/30 20:19 THREAD 5 C 09/30 19:07

MERGE 2 03/25 11:07 A 03/25 11:16 DATA CHECKING 03/25 11:04 C 03/25 11:04 IHS PATIENT MER 03/25 11:16 C 03/25 11:16 VA PATIENT FILE 03/25 11:16 A 03/25 14:57 3 44 8 THREAD 2 03/25 11:18 A 03/25 14:57 3 52 879268 THREAD 3 03/25 11:18 A 03/25 14:57 3 2 1364

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Section 6.3

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Merge Status• S (SCHEDULED) –The merge process has been

scheduled for some later time• A (ACTIVE) –The process is currently running• C (COMPLETED) – The job has been normally completed• H (HALT) – The job has been interrupted.• U (UNKNOWN-LOST) – An active job is no longer

updating• R (RESCHEDULED) – The process has been scheduled

to restart• E (ERROR EXIT) – The merge process has recorded an

error and is no longer running

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Section 6.3

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Combine Paper Files3

Paper Charts

John Tester

Johnny Tester

John Tester

Patient Index

Number Control Log

John Tester

Johnny Tester

67951 Tester, John70632 Tester, Johnny

Notify patient and providers

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Combine Paper Files

• Print face sheets for merged patients• Combines any paper files for the merged patients

– Charts– Patient indices

• Notify patients and providers of the merge

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Other Processes

• Tasks outside of the main merge process– Adding pairs of patients– Editing the status of a pair– Reporting– Manager functions

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Add a Duplicate Pair

• Adds a pair as potential duplicates• Duplicate score must be greater than the threshold• XDRMGR key allows bypassing the threshold

Section 5.2

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Add a Duplicate PairSelect IHS Patient Merge Option: S2Select Find Potential Duplicates Option: ADD Select VA PATIENT: DEMO,JAMESDEMO,JAMES D <A> M 02-12-1966 XXX-XX-1234

Another VA PATIENT: DEMO, JIMMYDEMO,JIMMY M 12-01-1966 XXX-XX-1234 CI 6031

You will be adding the following pair of records to the duplicate record file:

RECORD1: DEMO,JAMES D RECORD2: DEMO,JIMMY

Enter RETURN to continue or '^' to exit: <ENTER> Ok, continuing, hold on ...

This pair of patients has a duplicate percentage of only 40% whichis less than the minimal percentage for potential duplicates (60%). Patients not added!!!

Do you want to ADD another pair (Y/N)?

Section 5.2

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Edit a Pair’s Status

• Use this option if you accidentally give a pair the wrong status

• Changes the status back to Potential Duplicate, Unverified

• The pair can then work through the process again.• Status can’t be changed if the pair has already been

merged

Section 5.6

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Edit a Pair’s StatusSelect IHS Patient Merge Option: S1

Select Review/Verify Duplicates Option: EDIT

Select an Entry to RESET TO POTENTIAL DUPLICATES: PATIENT,ONE

Searching for a PATIENT PATIENT,ONE A M 6/29/00 000060969 ABC1234 ...OK? Yes// <ENTER> (Yes) PATIENT,ONE A VERIFIED DUPLICATE

Duplicate Record File Entry 948 for the VA PATIENT FILE1212 PATIENT,ONE888 PATIENT,ONE ACurrently listed as VERIFIED DUPLICATE

Do you really want to RESET to POTENTIAL DUPLICATE? NO// YES

Status RESET to POTENTIAL DUPLICATE RECORD.

Section 5.6

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Pause a Search

• Use to pause searching for duplicates• Restarting will start from where the search stopped

Section 4.1

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Pause a SearchSelect IHS Patient Merge Option: S1

Select Review/Verify Duplicates Option: SRCH

Duplicate VA PATIENT Search

Search Type Date Started Status hours:min # Records Checked----------- ------------------ --------- --------- -----------------BASIC JAN 4, 2007@08:17 RUNNING 0:12 545/26133 2.0%

6 Potential Duplicate pairs found

Do You wish to HALT this search (Y/N)? YES

Requested Start Time: NOW// NOW

Section 4.1

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Restart a Merge

• Reschedule a merge process after it has been stopped

• Use following stops due to errors• Restarts where the process stopped

Section 6.5

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Restart a Merge ProcessSelect IHS Patient Merge Option: S3

Select Merge Verified Duplicates Option: RMP Restart a Merge Process

Do you want to RESTART merge process TEST032907C? NO// YES

Requested Start Time: NOW// T@7PMRestart queued as task 4535

Do you want to RESTART merge process TEST033007A? NO// <ENTER>Do you want to RESTART merge process TEST040407B? NO// <ENTER>

Section 6.5

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View reportsSelect IHS Patient Merge Option: PMR

Patient Merge Reports(Your facility’s name)

LDAT List RPMS Data for a Patient PLD Print List of File Duplicates PLM Print List of Merged Patients TSM Tally STATUS and MERGE STATUS Fields

Select Patient Merge Reports Option:

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Tally Status ReportSelect Patient Merge Reports Option: TSM

TEST INDIAN HOSPITAL MAY 27, 2009 Page 1

TALLY OF DUPLICATE RECORDS' STATUS/MERGE STATUS FIELDS FILE: VA PATIENT-----------------------------------------------------------------------------Total Number of Duplicate Records for File VA PATIENT: 222

STATUS field: VERIFIED, NOT A DUPLICATE 1 POTENTIAL DUPLICATE, UNVERIFIED 212 REQUIRES RESOLUTION 0 VERIFIED DUPLICATE 9 VERIFICATION IN PROCESS 0

MERGE STATUS field: NOT READY 2 READY 1 MERGED 2 IN PROGRESS 4End of Report. Press return to exit

Section 7.4

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List File Duplicates - CaptionedUnverified Potential Duplicates MAY 20,2009 14:17 PAGE 1-----------------------------------------------------------------------RECORD1: PATIENT,DEMO RECORD2: PATIENT,DEMO A STATUS: POTENTIAL DUPLICATE, UNVERIFIED DATE FOUND: DEC 28, 2006 WHO CREATED: USER,IHS DC TOTAL POSSIBLE SCORE: 235 DC POTENTIAL DUPE THRESHOLD %: 60 DC DUPE MATCH SCORE: 235 DC DUPE MATCH PERCENTILE: 100

DUPLICATE TEST: NAME DUPLICATE SCORE: 100DUPLICATE TEST: SSN DUPLICATE SCORE: 0DUPLICATE TEST: TRIBE OF MEMBERSHIP DUPLICATE SCORE: 5DUPLICATE TEST: SEX DUPLICATE SCORE: 20DUPLICATE TEST: DATE OF BIRTH DUPLICATE SCORE: 60DUPLICATE TEST: DATE OF DEATH DUPLICATE SCORE: 0DUPLICATE TEST: MOTHER'S MAIDEN NAME DUPLICATE SCORE: 50DUPLICATE TEST: LAST SEPARATION DATE DUPLICATE SCORE: 0DUPLICATE TEST: CLAIM NUMBER DUPLICATE SCORE: 0

Section 7.2

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List File Duplicates - CaptionedUnverified Potential Duplicates MAY 20,2009 14:17 PAGE 1-----------------------------------------------------------------------RECORD1: PATIENT,DEMO RECORD2: PATIENT,DEMO A STATUS: POTENTIAL DUPLICATE, UNVERIFIED DATE FOUND: DEC 28, 2006 WHO CREATED: USER,IHS DC TOTAL POSSIBLE SCORE: 235 DC POTENTIAL DUPE THRESHOLD %: 60 DC DUPE MATCH SCORE: 235 DC DUPE MATCH PERCENTILE: 100

DUPLICATE TEST: NAME DUPLICATE SCORE: 100DUPLICATE TEST: SSN DUPLICATE SCORE: 0DUPLICATE TEST: TRIBE OF MEMBERSHIP DUPLICATE SCORE: 5DUPLICATE TEST: SEX DUPLICATE SCORE: 20DUPLICATE TEST: DATE OF BIRTH DUPLICATE SCORE: 60DUPLICATE TEST: DATE OF DEATH DUPLICATE SCORE: 0DUPLICATE TEST: MOTHER'S MAIDEN NAME DUPLICATE SCORE: 50DUPLICATE TEST: LAST SEPARATION DATE DUPLICATE SCORE: 0DUPLICATE TEST: CLAIM NUMBER DUPLICATE SCORE: 0

Section 7.2

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List Merged Patients

Select Patient Merge Reports Option: PLM Print List of Merged PatientsDEVICE: HOME// <ENTER> VT

MERGED PATIENTS MAY 20,2009 14:19 PAGE 1 DFN PATIENT NAME DOB SSN DATE MERGED------------------------------------------------------------------------------FROM: 3835 DEMO,PATIENT A 11/18/65 251413000 04/25/07 TO: 25238 DEMO,PATIENT 11/18/65 251413000

FROM: 25386 IHS,JOHN C 04/10/60 03/30/07 TO: 2845 IHS,JOHN C 04/10/60

FROM: 1111 TRAINER,TOM JR 02/11/73 200665921 02/09/07 TO: 8317 TRAINEER,THOMAS JR. 02/11/73 200665921

Enter RETURN to continue or '^' to exit:

Section 7.3

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Manager FunctionalitySelect IHS Patient Merge Option: DMU

Duplicate Manager Utilities(Your facility’s name)

PDUP Purge Duplicate Record File PMRG Purge Merge Process File RLMP Reset Lost Merge Process SITE Patient Merge Site Parameters

Select Duplicate Manager Utilities Option:

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Set Site ParametersSelect Duplicate Manager Utilities Option: SITE Patient Merge Site Parameters

Select DUPLICATE RESOLUTION FILE TO BE CHECKED: ? Answer with DUPLICATE RESOLUTION FILE TO BE CHECKED: VA PATIENT

You may enter a new DUPLICATE RESOLUTION, if you wish Please enter a file name or file number. MUST BE VARIABLE POINTER FILE IN FIELD .01 OF FILE 15 Answer with FILE NUMBER, or NAME Do you want the entire FILE List? Y (Yes)Choose from: 2 VA PATIENT 200 NEW PERSON

Select DUPLICATE RESOLUTION FILE TO BE CHECKED: 2 VA PATIENT ...OK? Yes// Y (Yes)

Section 8.4

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Set Site Parameters

FILE TO BE CHECKED: VA PATIENT____________________________________________________________________ MERGE MAIL GROUP: MY MAIL GROUP DUPLICATE MANAGER MAIL GROUP: MY MAIL GROUP POTENTIAL DUPLICATE THRESHOLD%: 60 DAYS BETWEEN VERIFY AND MERGE: 0 NUMBER OF THREADS: 3 REPOINT DELETED VISITS?: YES____________________________________________________________________

COMMAND:

Section 8.4

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Security Keys

BPMZMENU Gives access to the main Patient Merge menu.

XDR Gives access to the VA Duplicate Resolution System. Must be given to the same users as BPMZMENU.

BPMZMERG Gives access to the S3 menu.

XDRMGR Gives access to the Duplicate Manager Utilities menu and allows entry of a verified pair even if the threshold has not been met.

DG Eligibility Permits initiation of merge process and provides valid error checking.

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Process ReviewMergeReview and VerifySearch

Pat

ient

Mer

geA

pplic

atio

n S1/SRCHSearch for Potential

Duplicates

S1/PRNTPrint a List of

Duplicates

S2/VPDVerify

Duplicates

S3/AVDApprove

Duplicates

S3/SCHSchedule

Merge Process

Research Potential

Duplicates

Update paper chartsE

xter

nal

Pro

cess

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• Total pairs merged– Fort Defiance: 955 potential duplicates, 455 verified

duplicates – PIMC: ~1500 potential duplicates, half were verified

• Search frequency: Monthly & Bimonthly• New duplicates

– T numbers cause many new duplicates– Ensure that registration scans correctly

Beta Site Experience

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Beta Site Experience

• Possible errors– Merging locally created files, too many pairs at the

same time and choosing wrong mrege direction

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Beta Site Experience

• Recommendations from Beta Sites– Carefully manage your queued merges.  PIMC

recommends 3 pairs per process, scheduled the merges 2 hours apart. 

– Limiting the number of users.– Be very thorough on your research. – Collaborate with other departments.– Keep site parameters set to the default values.

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Next Steps

• Install at your site• Revise national HIM policy to meet your facility’s needs• Notify when you begin your first search.

– Area HIM Consultant– Rebecca Herrera

• Call Help Desk with problems: (888) 830-7280

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Questions?