Data integrity is a major concern with electronic health record systems, regardless of the substantial benefits they offer, ranging from better care and reduced healthcare costs to ease of processes such as medical record retrieval and analysis for medical litigation purposes. EHRs allow the collection, analysis and sharing of clinical data between providers, improve patient experiences and outcomes, and enable patients and their families to make better treatment decisions. They offer healthcare providers the smart analytics required to function more efficiently, save time and cost, and improve margins with increasing initiatives of value-based care.
So what is it about EHR data integrity? Poor EHR system design and wrong use of these systems have resulted in medical errors that put at risk the integrity of the information in the electronic health record. Patient safety and quality of care provided is compromised. In addition, such unintended consequences could also lead to increase in fraud and abuse and consequent legal implications. In November 2017, a $1 billion class action lawsuit was filed against the EHR vendor eClinicalWorks, and the suit alleges that this vendor’s cloud-based EHR system failed to provide reliable health information for potentially millions of patients. Therefore, “patients and doctors cannot rely on the veracity of those records,” the lawsuit said. This class action lawsuit was filed five months after the Department of Justice announced that eClinicalWorks agreed to pay a $155 million financial settlement with the Department of Health and Human Services’ Office of Inspector General. According to the Justice Department, the company falsely claimed it met the HITECH Act EHR incentive program’s certification requirements while it actually didn’t meet the requirements of accurately recording user actions such as orders for diagnostic tests that are conducted in the course of a patient’s treatment, and ensuring data portability.
The class action lawsuit highlights the following shortcomings of the EHR system. The software,
- Displayed incorrect medical data in the right chart panel of the patient screen periodically
- Periodically displayed multiple patients’ information at the same time
- Failed to accurately display medical history on progress notes in specific workflows
- Failed to ensure audit logs accurately record user actions. Sometimes the audit logs even misled users regarding the events conducted in the course of a patient’s treatment.
These shortcomings resulted in millions of patients having their medical records compromised, and the patients cannot rely on the accuracy and reliability of their medical records. The patients have no way to know whether their records were altered, deleted, or modified. The class action lawsuit was filed in a New York district court by Kristina Tot, the administrator of the Estate of Stjepan Tot “on behalf of herself and all others similarly situated.” Before his death from cancer, Stjepan Tot learned that eClinicalWorks failed to accurately display his medical history on progress notes. In particular, he was unable to determine reliably when his first symptoms of cancer appeared in that his medical record failed to accurately display his medical history on progress notes.
While it is true that EHRs can increase the amount of information available to healthcare providers, if effective patient care is to be ensured, a high level of data integrity should also be ensured. AHIMA points out that data integrity means “data should be complete, accurate, consistent, and up-to-date.” Providers gain little value if inaccurate or outdated data resides in the EHR. An AJMC study found that EHR problem lists particularly lack in data integrity, and that they are not accurate enough for risk adjustment. These problem lists comprise patient diagnoses entered into the EHR by clinicians during patient visits. These lists are not regularly updated, and are largely inaccurate. EHR problem list-based co-morbidity assessments therefore have poor sensitivity for identifying major co-morbidities. Inaccuracy of EHR problem lists in identifying major co-morbidities for risk adjustment could have negative financial consequences for physicians with the increasing focus on value-based care now.
Efficient EHR systems that can meet the desired objectives are what all stakeholders including medical claims review companies eagerly await. Healthcare organizations are adopting strategies such as the following to improve EHR data integrity and use.
- Implementing data validation technologies into EHR systems to confirm the accuracy, meaningfulness and security of data.
- Developing user-friendly information portals where consumers can access their health records and provide feedback on missing or inaccurate data.
Improving the health data governance policies of healthcare organizations could help in the effective utilization of EHR problem lists for risk adjustment. It would also enhance data integrity and improve the quality and accuracy of EHR data. When data integrity and diverse data integration are ensured, providers benefit from more complete patient information that is so important for optimal care delivery.