Medicare to act on duplicate and intertwined records

The Department of Human Services (DHS) has established a program of work to identify and cleanse the Medicare Consumer Directory of duplicate or intertwined records, which an Auditor-General's report says can pose a clinical safety risk.

Last week, the Australian National Audit Office (ANAO) released the results of an independent performance audit of the integrity of Medicare customer data. While the report found that the number of duplicate and intertwined records was not significant considering the amount of data Medicare manages, corrective action still needed to be taken.

Duplicate records were a matter of concern in terms of the potential for fraud but also clinical safety. The report says that following the introduction of Individual Healthcare Identifiers (IHIs) in mid-2010, DHS undertook a data cleansing exercise to identify duplicate Medicare customer enrolments.

This recognised the risk that if both enrolments were active and the customer requested a PCEHR, their clinical data would be incomplete as it would only reflect the data recorded on one record, the report says.

Despite this data cleansing exercise, the audit found at least 18,000 possible duplicate enrolments, which posed an ongoing data integrity issue in the Medicare customer database, it said.

Another area of concern was intertwined records, defined as a record held in Medicare's Consumer Directory database which is shared by two different customers. This gave rise to both privacy and clinical safety risks, the ANOA found.

“Intertwined records are created when customer service officers incorrectly enable two customers to use the same PIN – customers’ unique Medicare enrolment identifiers. Human Services advised that it has recorded 34 intertwined records since 2011-12, when it commenced recording identified instances,” the report says.

“These records represent a clinical safety risk to customers as their recorded health data is combined with the health data of another customer. It also represents a privacy risk if one of the customers views their personal and/or health data, including claiming history, through a Medicare Online Services account, Personally Controlled Electronic Health Record, Medicare Express Plus mobile phone application account or by requesting a copy of their claims data from Human Services.”

The report states that intertwined records are difficult to identify and have been brought to DHS's attention by customer queries. “For example, Human Services identified one intertwined record for two children after the parent of one of the children received an immunisation certificate for the other child and contacted Human Services.”

DHS has responded to the audit by setting up a program of work that will undertake a comprehensive analysis of the Consumer Directory to identify and analyse the extent of intertwined records by June.

It has also undertaken to cleanse the directory of any intertwined records by September, and to identify “risk points” for the creation of intertwined records by October.

It will also establish an escalation framework to capture intertwined records at the time of creation to allow for prompt corrective action by the end of the year.

Posted in Australian eHealth

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