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The LENUS [LE08] master patient index in combination with the electronic patient record and a healthcare service bus enables the implementation of a small lean reference system for patient management. Via a modern client all ADT functionalities can be applied without a leading administrative software system. Based on service oriented architecture the index is used in combination with a preconfigured open source healthcare bus. It uses the association based search engine of the LENUS HCM software suite [LE06] to reach a high re-identification rate of existing patients. Only few cases must be processed manually in the LENUS clearing component.