Modifying the Admission Process to Improve the Collection and Accuracy of REL Data Collection

Methodist North Hospital, Memphis, Tennessee
    • September 29, 2010

Ensure accurate collection of patient self-reported demographical information.

Implemented changes in the hospital electronic medical record (EMR) and patient in-take process to improve the collection and accuracy of race, ethnicity and language (REL) data collection.

Prior to implementation, race data was not being collected in any standardized manner and ethnicity data was not being collected at all. Now 100 percent of patients at Methodist North Hospital are being asked their race, ethnicity and preferred language and this information is permanently recorded in their EMR.

Methodist North Hospital
3960 New Covington Pike
Memphis, TN 38128
Ph: (901) 516-5200

From the C-Suite:
“Our successes depended on our ability to carefully plan what needed to be done, know who to involve and craft the right messages to implement rapid change.”

Paula Jacobs, M.A., S.S.B.B.
Director of Quality Performance and Improvement, Methodist North Hospital

Methodist North Hospital is a 254-bed comprehensive community hospital offering emergency services, cardiac care, robotic surgery and an orthopedic center.

Clinical areas affected:

  • Admissions

Staff involved:

  • Admissions staff
  • Information system engineers

It took less than a week to change the hospital’s EMR and a month of training with admissions staff.

Paula Jacobs, M.A., S.S.B.B.
Director of Quality Performance and Improvement, Methodist North Hospital
Ph: (901) 516-5702

Innovation implementation:
Misconceptions persist in society about the definitions of race and ethnicity as the two are often used synonymously. However, there is a significant difference between a person’s race, a group of people distinguished by genetically transmitted physical characteristics, and ethnicity, a shared culture reflected in language, religion, and other qualities. In the clinical setting, this difference is important to recognize as care may need to adapt to patient in order to ensure that the highest-quality of care is delivered.

In committing to improve the care for all patients regardless of race, ethnicity and preferred language, the team at Methodist Hospital came across two hurdles that would impede the accuracy of collecting these data: the hospital’s EMR, which stores patient demographical information and medical histories, did not have separate fields for race and ethnicity. Additionally, admissions staff tended not to ask patients about their demographical information or language preferences, instead resorting to practices such as “eyeballing” the patient to get answers and fill in the EMR.

To address these challenges, the team worked with the hospital Information System (IS) Department staff to alter the EMR and trained the admissions staff on new registration procedures. Giving them an initial lead time of several months, the IS Department was actually able to make modifications to the EMR within a week to separate the race and ethnicity fields. Working with the admissions staff to reform the registration process, however, took a greater length of time.

Admissions staff were understandably hesitant about asking such sensitive information. The team presented admissions staff with data and information about health care disparities and reinforced that the reason for asking was because they cared and it would lead to better health care for all. After securing their buy-in, the team gave admissions staff a script to use when asking patients for their demographic information, which contained explanations about why collecting this information is important.

Advice and lessons learned:

  1. Plan carefully and be patient. Changing the systematic backbone of any institution will require time, patience and persuasion.
  2. Engage the right leaders. Talk directly with the people charged with managing existing systems as they will be in the best position to shepherd your change along.
  3. Don’t get sidetracked by negative feedback. Be prepared to offer answers on why focusing on patient demographical information will lead to improved outcomes. Realize that this is a very sensitive subject for some.

Cost/benefit estimate:
Outside of staff time, there were no costs to modify the EMR or train admissions staff.