Submitted by Emily Graham, RHIA

When a healthcare facility decides to convert from their legacy system to a new information system, there are many tasks that must be completed during the course of the project. One of the most important tasks is the conversion of the Master Patient Index (MPI). The MPI conversion is a project that requires a great amount of time and attention to be successful. Most systems have tools that assist with the process to maintain a consistent flow of information and focused patient care.

This process may begin prior to table build if the data needs to be cleaned up on the legacy system prior to conversion to the new system. The Health Information Management Department and all registration areas, as well as a representative from Quality Improvement should work closely with a technical resource in Information Services to assure that the information is converted accurately and completely, both during the initial conversion process and any subsequent processes used to “catch up” the data from the previous run.

There are many strategies to tackling this effort, and many lessons have been learned through various conversions that could be useful to any facility approaching this task. Outlined below are a few basic guidelines that could save time and resources.

1. Consider disk space: It is common for facilities to be reluctant to give up the amount of data maintained on the legacy system. However, when converting the MPI, the disk space available on the new system should be considered so that system performance is not hindered. Typically, two to five years of patient data are converted without difficulty, but system capabilities must be verified. It is also wise to consider not converting some data that may no longer be valid, such as patient and relative addresses, guarantor information, place of employment, telephone numbers, etc. This information is available on the patient’s medical and/or billing records if needed at a later date. The Billing Department, ancillary services, and anyone who develops statistical reports should be consulted when determining needs. Some laboratory regulations may require a longer retention time, and should be considered.

2. Clean up the data being converted: Cleaning the data in the MPI is a time-consuming and very involved process, but is worth the effort to have consistent data for patient care. The formats of patient and relative names, special characters, and length of the fields must be considered when converting to a new system. If the legacy system allowed for special characters, but the new system does not, it is prudent to begin a clean-up process early to remove the characters since they may cause the patient’s record to be rejected in the conversion process. There may be an error log in the MPI conversion functions for the new system that will assist in the process.

A concentrated effort toward cleaning up duplicates in the Master Patient Index should be undertaken as soon as possible to assure appropriate conversion of patient data. Any duplicates or incorrect information in the legacy system’s MPI will be converted to the new MPI. Work with Information Services personnel to assure that an increased number of merges will not hinder the legacy system’s performance. Work with other departments such as Radiology and off-site storage companies to assure that any physical folders that need to be merged are maintained throughout the process.

3. Prepare “cheat sheets”: When determining needs for the new system’s MPI, prepare a document that depicts the current MPI data and what fields are available for conversion to the new system. Once these determinations are made, prepare another document that shows what the MPI data will look like post-conversion. This helps all users see the potential changes and make revisions prior to conversion. Create mapping table documents that will assist users when reviewing the converted MPI data.

4. Verify that defaults are valid: When converting tables into the new MPI, such as patient type, discharge disposition, hospital service, etc., a default value may be required. A default value will be used when a piece of data from the legacy system has a value that is not defined in the mapping tables. This value should be considered carefully for each table so that the data will be useful at a later date to anyone who references the converted data. For example, if the default disposition value was set to equal “expired”, any patient with a value not mapped would be marked as expired and the new system may stop the patient from being registered on his/her next visit. It is best to try to limit the number of records that are given a default value, as this will affect statistical reports in the new system.

5. Use available MPI conversion functions: The MPI conversion functions in the new system should provide tools to verify the data that was converted. An error log is a useful tool to determine errors, and may give summaries of converted data. Records with fatal errors may not be converted to the new system. Reviewing the errors in this log should give an indication of where potential problems exist. A tool may be provided to quickly define values that are rejected or to determine how many pieces of information were converted to default values. These tools may be used to update mapping tables or clean up data so that fewer records are rejected.

6. Test the conversion process as often as possible: Multiple test conversions should be run prior to the final conversion, including three to five complete conversions to verify disk space and time needed for conversion, and many small tests to verify mapping of tables, location of data elements in the correct spaces, and to reduce the number of rejected records. Records reviewed need to include records that are to be converted as well as records that are not to be converted, so that the selection criteria may be validated. A representative sample should be reviewed by employees in Health Information Management, Patient Registration, Information Services, Quality Improvement, ancillary services, and other departments as deemed necessary. The information must be verified against the legacy system and all discrepancies should be marked and reported to the leader of the project so that the record may be reviewed in the error log and corrected on the appropriate system. Representatives from all departments should view the MPI as it will appear in the new system, to understand the changes that will occur. This may include new table entries, information that will not be converted, or default values that are used. All users will need to recognize the changes and be able to transition to the new MPI as soon as possible after conversion.

There are many other details to be considered when converting a Master Patient Index so that there is no disruption in patient care. The MPI Conversion process is lengthy and time-consuming, but with a few dedicated, detail-oriented team members using all of the tools and strategies available, the time will be worth the effort.