Hospitals and doctors say EHRs allow them to better document the work they have always done, generating more accurate claims than before while meeting growing demands for efficiency. Critics say functions such as cut-and-paste make it too easy to bill for work that wasn't actually performed, especially when the copied material comes from a different patient's record.
That has led to studies to see whether EHRs are enabling illegal upcoding. Officials at the U.S. Justice Department and HHS jointly published an open letter to healthcare providers in September 2012 warning that there are indications some companies were using the technology to game Medicare. “Certain EHR documentation features, if poorly designed or used inappropriately, can result in poor data quality or fraud,” according to the report from the OIG.
The cut-and-paste function sometimes is implicated in problems with the quality of care, such as when incorrect information gets entered into a patient record by mistake. “Every once in a while, a 75-year-old gentleman will turn into a 30-year-old woman, on the basis of cutting and pasting the wrong information into the chart,” said Dr. William Bria, chairman of the Association of Medical Directors of Information Systems. “I've seen this personally.”
But Bria said most providers who use cut-and-paste are simply trying to be more efficient. “Most people really do try to do the right thing, but it hasn't been easy,” he said. “Why would I type in my (patient's) history every single time? That's crazy.”
Not all of the potential solutions to these problems involve greater regulation. Dr. Adrian Gropper, chief technology officer of the not-for-profit Patient Privacy Rights, in Austin, Texas, said it would help if patients were allowed to view the audit logs on their own records.
“The logs exist,” he said. “And patient portals exist. And the software for doing the automated access to the portal already exists. If there was simply access to the logs in real time … it would make upcoding a lot more risky. This level of sunshine on the logs would directly address some of the concerns related to the inspector general's report.”
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