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Sloppy EHR Data Signals Need for Standards

Joe Cantlupe, for HealthLeaders Media, February 21, 2013

Often, the problems have nothing to do with the evolving technology, but simply the process used by physicians and other healthcare providers in their utilization of EHRs. For instance, documentation produced by cutting and pasting information from previous patient visits "continues to be a significant problem" that creates "unnecessary redundancy and at times inaccurate information," Dougherty says.

"This can lead to clinicians checking off services they haven't performed or material being incorrectly copied and pasted," she told the committee. "If clinical documentation was wrong when it was used for billing or legal purposes, it was wrong when it was used by another clinician, researcher, public health authority or quality reporting agency."

Dougherty calls the improperly copied information as "cloned" material. That could include social, medical and family histories; visit/clinic notes, inpatient progress notes, consults, vital signs and reviews of physical exams. "We may need records [from] two years ago, but we need to know these records actually [reflect] what happened then and haven't been modified over time because of system updates," she told me.

Ivy Baer, senior director, regulatory and policy group at the Association of American Medical Colleges also expressed concerns about how the written record is being used in EMRs in testimony before the HIT committee.  The AAMC represents all 141 accredited US and 17 accredited Canadian medical schools as well as 400 major teaching hospitals and health systems.

"Unlike a note written on paper, a note written in an EHR can be generated by using information that already has been recorded elsewhere," Baer told the committee. "The result can be a note that appears to be new and contemporaneous but actually is a combination of pre-existing material. Incorporating information that is not original to the author onto a note has the potential to jeopardize patient care and expose providers and/or institutions to liability."

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3 comments on "Sloppy EHR Data Signals Need for Standards"


Reed D. Gelzer, MD, MPH (2/25/2013 at 3:51 PM)
Thank you for the summary article. It is odd that Ms. Dougherty apparently did not mention that extensive EHR System Standards already exist, as well as wide ranging Best Practices in Records Management. Ms. Dougherty was Chair or co-Chair of the Records Management and Evidentiary Support Profile Standard (RMES) Workgroup from its inception in 2004 thru 2011 and presided over RMES's publication as a Normative Standard in 2010, addressing most, if not all, of the gaps she correctly highlights in her comments. The problem, therefore, is not a lack of Standards, it is a lack of use of Standards by vendors, policymakers, and by clinical provider organizations. This is only one element of the current EHR System landscape that demonstrates how, to a great extent, the lack of data quality and information integrity support functions in EHRs has nothing to do with lack of systems capability or knowledge of what constitutes "fitness" in Records Management Systems. With this in mind, please consider a follow-on article to provide your readers with information correcting the impression given by your article that Standards pertinent to data quality and information integrity do not already exist, so that they may better understand the a number of important practical facts: 1. Standards and supporting due diligence tools exist to assure purchase, implementation, and use of EHRs supporting data quality and information integrity, as well as Billing Compliance and, 2. the damage being wrought by Federal subsidies for implementing systems that are not required to meet even the most basic fundamental requirements for a trustworthy electronic patient record, including data quality and information integrity. This would be a substantial and useful public service, as well as a proper credit to the HL7 Standards that Ms. Doughterty helped create, among the many hundreds of other HL7 Standards contributors. Reed D. Gelzer, MD, MPH Currently co-Chair of the HL7 Record Management and Evidentiary Support Workgroup.

Gus Geraci, MD (2/21/2013 at 4:07 PM)
Standards for use and storage would be lovely, for interoperability and many other reasons. The trick is to maintain or improve workflow and usability, many of which have been degraded by MU already. Beware the quest for improvement which degrades with many unintended consequences.

Robert Modugno MD MBA FACOG (2/21/2013 at 2:14 PM)
In their haste to bring EHRs to market both new and old school physicians are having teething problems. Most of their time is spent on data entry rather than on patient care. So far, most docs I know are uncomfortable with EHRs finding them cumbersome and time consuming and therefore they decrease productivity.Different systems don't talk to each other, thus quality medical care is compromised, tests are repeated, etc. The only "winners" are the insurance companies, the govt and the EHR companies. They are still not ready for prime-time IMHO. The doctors will end up taking "the blame" and the extra litigation. Robert Modugno MD MBA FACOG Marietta GA ( Recovering EHR user - three systems so far...)