EHR standards sought to cut tech-induced errors

Despite the proliferation of electronic health record systems, there have been no norms regarding data governance.

By — Posted Oct. 15, 2012

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A leading health information management organization wants to standardize the way data are collected, stored and used by electronic health record systems so that the promise of EHRs may finally be realized and not unwittingly jeopardize physicians who use them.

The American Health Information Management Assn. in November is convening stakeholders — including health care professionals, health plans, quality organizations and vendors as well as the Dept. of Health and Human Services — to establish guidelines that vendors and health care organizations can use to address data integrity, patient safety, quality and the prevention of billing errors.“Unified data governance principles will help promote accuracy and consistency and reduce ambiguity,” AHIMA CEO Lynne Thomas Gordon said in a prepared statement. The organization held its annual meeting Oct. 1-3 in Chicago.

AHIMA says the need is urgent given the rapid deployment of EHRs, which has led to many health care organizations developing procedures and processes for the management of health care data in a somewhat ad hoc way. The move comes when the industry is moving toward increased interoperability between health care organizations and patient engagement, both of which will rely on more data sharing and use. It also comes when federal and state regulators are cracking down on billing fraud and data privacy and security.

Resolution agreements

HHS has announced several resolution agreements regarding violation of privacy and security rules outlined in the Health Insurance Portability and Accountability Act. Meanwhile, U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius sent a letter to five hospital organizations on Sept. 24, stating there were “troubling indications” that some unspecified “providers” were using EHRs to “game the system, possibly to obtain payments to which they are not entitled.” The letter followed a report by the Center for Public Integrity claiming that Medicare has paid $11 billion in inflated fees in the past decade and that EHRs are contributing to that inflation.

The American Hospital Assn. responded that although fraud is not tolerated, “it’s critically important to recognize that more accurate documentation and coding does not necessarily equate with fraud.” The AHA also said the Centers for Medicare & Medicaid Services should embrace national hospital coding guidelines that can help provide clearer guidance.

Although many physicians argue that EHR systems help them code more accurately, some health information specialists say improper use of EHRs can cause coding errors that are not intentional but could be treated as such.

AHIMA hopes that developing standards for how EHR systems are designed and used will produce better clinical documentation, said Michelle Dougherty, director of practice leadership at the organization.

Physicians in small practices have an important role in understanding how EHR systems work and whether patient visits are documented properly, said Diana Warner, director of health information management solutions at AHIMA.

Often the design of EHR systems, intertwined with how they are used, causes problems. For example, some EHR systems will provide yes and no check boxes for body systems that were examined. If the EHR defaults to yes on those check boxes, thus showing that all the body systems on the list were checked by the physician, and the physician fails to uncheck the systems he or she did not examine, the record would reflect something that didn’t happen.

Dougherty said that as more physicians implement patient portals to comply with stage 2 meaningful use requirements, patients might help them identify problems with documentation. When patients have access to their records, they may find that the records don’t reflect what the physicians did during an exam.

Data governance

Several educational sessions at the AHIMA conference focused on data governance issues that the organization plans to address in its recommendations. In one session, Deborah Robb, director of physician services at TrustHCS, referred to two bad habits she called “viruses” because of their ability to spread through a practice: the “copy and paste virus” and the “click-happy virus.” TrustHCS, a health care consulting firm based in Springfield, Mo., focuses on coding compliance.

Robb said she understands that physicians want to streamline the documentation process by copying and pasting notes from one visit to the next, but the HHS Office of the Inspector General has made clear that it will look for copied clinical notes in audits. She said physicians can accidentally code incorrectly by clicking through several screens to save time.

AHIMA said it plans to bring industry leaders together in November for a summit on data integrity. It will take findings from the summit, as well as feedback from members, to publish recommendations on how best practices for data governance can be put in place. The organization expects to publish the recommendations in 2013.

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