OIG report recommends greater EHR oversight

The promise of electronic health record systems has always been tempered by the need to implement stringent security policies to keep the data the software stores safe. The Centers for Medicare and Medicaid Services has gone back and forth with health care industry executives to determine the proper course of action when it comes to protecting patient information, but little has come to fruition as of yet.

According to a recent report from the U.S. Department of Health and Human Services' Office of Inspector General, the CMS must continue to do more to ensure the validity of EMR systems as viable stores of patient data. In particular, the report focused on ways to reduce billing fraud and generated ways the industry could leverage EHR functionalities to produce smoother workflows.

Cutting back on fraud
EHR systems have the potential to collect and categorize so much patient health information that the risk of losing certain pieces of data within the overall systems continues to grow. As more patient profiles are completed and updated within EHR software networks, the instances of incorrect or overdocumentation continues to grow as well.

According to the OIG report, the latter issue is not being addressed adequately by the CMS. EHRs continue to face problems of repetitive data points and errors at the point of data entry. However, rather than calling on physicians and health care professionals to fix these problems, the OIG placed the blame at the feet of the CMS.

The report indicated that the CMS had not provided adequate guidance to contractors on best practices regarding fraud avoidance. One of the most common ways that fraud – either deliberate or inadvertent – occurs is through errors in data entry. However, the OIG found that even though most EHR systems have an accessible and user-friendly copy-and-paste function to transfer data from one source to another, only 25 percent of hospitals in the U.S. had codified policies on how and when to utilize this feature to reduce the instances of fraud.

If organizations can implement such practices, the OIG estimated that it could save $3.1 billion in recovered funds. The agency pursued 465 criminal and 266 civil actions in the past six months, and more widespread copy-and-paste usage could help reduce these numbers.

Putting the spotlight on the CMS
This is not the first time that the OIG has publicly addressed the CMS as the source of problems with EHR systems. In a report published in January 2014, the OIG found that the CMS had no clear policies for how its contractors reviewed data in EHR systems. In fact, there was no qualitative difference in the way paper-based and electronic sources were reviewed. 

Leon Rodriguez, director of the HHS' Office for Civil Rights, explained in a meeting with the American Bar Association that better use of EHR systems – and not better EHR systems themselves – is what the industry needs right now.

"The failures are not due to technology," Rodriguez said, according to FierceEMR.