Study cautions e-health records may feature important gaps

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BOSTON (STATE HOUSE NEWS SERVICES) – An early adopter of electronic medical records showed “significant missing data” within its e-records for patients with a diagnosis for depression or bipolar disorder throughout 2009, according to a study released Thursday by Harvard Pilgrim Health Care Institute.

While the study focused on behavioral health within a particular provider group, it cautioned more broadly that incomplete data is characteristic of the entire system of electronic medical records.

The study advised physicians to be “fully cognizant of the information gaps and disconnects that lie behind the screen” and warned that incomplete e-health records could provide a “false comfort.”

The study looked at more than 5,500 patients insured through Harvard Pilgrim and assigned for primary care to Harvard Vanguard Medical Associates, a practice of Atrius Health and an “early pioneer” in e-health records.

“This is not about Harvard Vanguard,” the study’s principal investigator, Stephen Soumerai, of the Harvard Pilgrim Health Care Institute, told the News Service. Soumerai said data-sharing has hardly improved in the more than six years since the health events analyzed for the study.

The study released Thursday, which compared insurance claims to e-health records through 2009, found major gaps in the particular population it reviewed. About a quarter of depression and bipolar diagnoses were not recorded and almost 90 percent of acute psychiatric services at hospitals were not included in the e-health records, the study found.

The 2009 federal stimulus law included rules dictating that by 2015 more than 500,000 doctors in the country and almost 6,000 hospitals should have e-health records and health information technology systems or be subject to penalties in Medicare reimbursement, the study said.

A lack of interoperability between e-health systems has threatened the goals of improved information-sharing about patients’ medical history, the study said.

“Federal efforts have been undermined by the inherently fragmentary nature of the US healthcare system and the proliferation of proprietary [electronic health record] systems that communicate poorly with each other,” said Soumerai in a statement. “Going forward, our national policy for investment in [electronic health records] needs to be re-examined to surmount the fragmentation that currently exists in US healthcare and to set robust technical standards for interoperability and data quality.”

Since 2000, Harvard Vanguard “has relied on Epic, the most popular” e-health system in the country, said the study, which reported there are “hundreds” of e-health systems in use.

Electronic health records have the potential for doctors to almost instantly call up a patient’s history, avoiding the time-consuming and imperfect shuffle of paper records.

“Atrius Health has a large and highly integrated behavioral health and primary care practice with advanced health information technology,” Dr. Jacob Kagan, specialty director for Behavioral Health at Atrius Health, said in a statement. “Nonetheless, the fragmentation of the behavioral health delivery system poses significant challenges even for us.”

Atrius Chief Strategy Officer Marci Sindell said in a statement to the News Service that the company built a web portal in 2010 allowing its clinicians “to safely view electronic health record information with partnering organizations outside of our network to help close gaps in care.”

Faulty e-health records can have dire consequences. Thursday’s study referenced a prior study into malpractice filings, identifying 147 cases where e-health records “contributed to patient harm” with 46 of those resulting in death.

“To the extent that medical decision-making grows increasingly automated and reliant on new information technologies, care will suffer if there is overreliance on data that are in fact incomplete,” the study said.

The study suggested improvements might be achieved by insurers sharing claims data with e-health systems and clinicians as well as “patient-driven data-sharing mechanisms.”

Both federal and state government have encouraged development of electronic health records. In October 2012, Gov. Deval Patrick made the first transmission over the Massachusetts Health Information Exchange, sending his personal health information from Massachusetts General Hospital to Baystate Health in Springfield.

The health information exchange had earlier in 2012 received $16.9 million in federal stimulus and Medicaid funding.

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