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Sloppy EHR Data Signals Need for Standards

Joe Cantlupe, for HealthLeaders Media, February 21, 2013

Motivated by improved efficiencies and monetary incentives, healthcare is migrating to electronic health records. While this solves the issue of physicians' sloppy handwriting on paper, and creates a host of opportunities for the digitized data, it is creating a new set of challenges.

Experts are examining what doctors are entering into the EHRs, what they meant to enter, and how the information is translated. What they are finding is that plenty of mistakes are making their way into the clinical documentation process, never mind outright abuses.

"Accuracy and the quality of clinical documentation is an issue," Michelle Dougherty, MA, RHIA, CHP, director of research and development for the Chicago-based American Health Information Management Association, told me. "There's a concern about significantly compromised information captured in the EHRs. There's a lot of redundancy in the process."  AHIMA represents 67,000 health information management professionals.

"As more and more organizations have only electronic medical records, how they were created and maintained is coming into question," Dougherty says. "There has to be an infrastructure that shows how the information is handled through the lifecycle of the records, that there was proper authentication, and that it was preserved without alteration." Assurances need to be built into the process to track the authenticity of authorship for any notes entered in documentation.

I spoke with Dougherty recently in the wake of her testimony this month before the HIT Policy Committee's Meaningful Use Workgroup and Certification and Adoption Workgroup, which held a hearing on Stage 3 issues in Virginia. The Health HIT Policy committee makes recommendations to the National Coordinator for Health HIT on a policy framework for the development and adoption of a nationwide health information infrastructure.

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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...)