Electronic well being information (EHRs) are supposed to document sufferers’ correct and full medical historical past, but it’s no secret that these programs have their share of issues. Common points embody duplicated patient information, prescription authorization errors, billing errors, and patient misidentification. While merely copying and pasting affected person info from earlier visits to replace affected person charts might initially assist in saving workers time, what occurs when a shortcut like this fails to seize {that a} affected person has died?

It seems that inconsistencies round affected person demise standing within the EHR is a reasonably widespread prevalence. A recent report in JAMA Internal Medicine investigated the prevalence of outdated EHR info utilizing information from significantly ailing sufferers at UCLA Health. From the 12,000 sufferers recognized on this class, 676 have been marked alive of their well being information however have been really useless in state public information.

It will get worse.

As these sufferers have been nonetheless assumed to be alive, 541 of them nonetheless had appointments scheduled after their demise. These sufferers continued to be contacted by well being care workers and obtained roughly 221 calls and 338 portal messages unrelated to their deceased standing. Additional contact makes an attempt urged these sufferers to get preventative care like flu pictures and most cancers screenings, and drugs have been nonetheless being licensed for a minimum of 88 useless sufferers. 

This mistaken follow-up is just not solely wasteful for the well being system, it could possibly be upsetting for relations to obtain these messages. Inconsistencies in EHR information may be perpetuated in AI algorithms educated on this information, which might make these instruments much less correct. 

Drivers of EHR inconsistencies

Part of the issue lies within the fragmented nature of EHRs. The common well being system makes use of 18 different EHR vendors throughout affiliated suppliers. But these EHR programs aren’t always able to speak to at least one one other, which means sufferers should wrestle to entry their information, docs might order duplicate testing, or have to switch well being information with fax or a CD. With so many information sources attempting to supply a complete view of the affected person, it’s straightforward to see why a affected person could also be marked as deceased in an EHR used for inpatient companies however their specialist or major care physician might do not know. And the truth that many EHRs can’t hyperlink up simply with federal and state information makes recording affected person deaths a a lot more durable activity.

Even with out interoperability points, verifying affected person demise is just not straightforward. Health programs need to entry state information to verify affected person demise, and ease in state accessibility varies. Even if the affected person is present in state information, if they’ve a standard identify, there will not be sufficient info for well being programs to confirm that it’s the proper individual. Research companies need to be contracted out to do a deeper search, but when the affected person can’t be linked to a social safety quantity, or the knowledge of their EHR is inadequate, a deceased standing can’t be formally confirmed. Internal departments typically shouldn’t have an organized system or incentive to confirm a flag in a affected person’s chart indicating their demise. 

Dr. Eric Cheng, chief medical informatics officer at UCLA, defined challenges with coordinating this info, in an interview with StatNews: 

“If a patient were to call the clinic or a doctor and say a family member died, we don’t necessarily do the best job in documenting that the same way. Physicians don’t know whether that’s stored, the front desk clinic may not be comfortable if they’ve never heard of the patient — they would all document in the note, but not in the official place where it should be.”

Dr. Eric Cheng, chief medical informatics officer at UCLA, in StatNews

How can EHRs be improved?

Creating necessities and requirements for interoperability has been a goal for CMS for many years—and now it seems actual change is lastly on its means. CMS launched the Trusted Exchange Framework and Common Agreement (TEFCA) in December 2023, offering much-needed requirements and permitting public-private collaboration to handle gaps in well being info change throughout EHR programs. Five organizations often called Qualified Health Information Networks (QHINs) are formally signed on to make use of this framework and may begin exchanging information instantly. Hopefully, many others will observe. 

Patient misidentification not solely contributes to poor monitoring of demise information however may also trigger trauma and delayed care. To stop this, one other potential resolution is creating distinctive affected person identification numbers, a coverage supported by some specialty teams, well being programs, and trade organizations. 

A big a part of making hospitals extra accountable begins with having an environment friendly EHR system that retains affected person values as the main focus. As options are being pushed, we hope to see benefits additionally impression total well being programs by stopping doctor burnout, decreasing administration prices, and offering prime quality care.