Information in medical decision making: how consistent is our management?

Discriminant Patterns of Consistency in Health Data Dictionaries: Implications for Evidence-Based Medicine

An increasing amount of the medical information in health provider organizations is derived from electronic patient records (EPRs). As such, the quality of information maintained by healthcare organizations becomes a key component of the healthcare delivery process, with a corresponding need for consistent information collection and management methods. The objective of this study was to examine and compare adoption rates of EPR data reliability within clinical support systems, identifying regional variation across the USA. In a nationwide study of all accredited US health information managers, reported levels of data dictionary adoption in electronic patient records were examined. Results show that the majority of health information managers have widely disparate policies and procedures related to data consistency. Despite increasing reliance on consistency of data for comparative purposes, most organizations have not exhibited regular adoption of data dictionaries to uniformly define system-based information within their organizations. This occurs in an era where government-mandated data standards require greater uniformity of medical information. Utilization of EPR data in evidence-based medical decision making must be undertaken with caution, especially when outcomes or other decision support data are compared across states or regions.

Disparities in health information quality across the rural-urban continuum: where is coded data more reliable?

The growing application of evidence-based medicine practices across U.S. healthcare has created greater dependence on information resources, especially related to quality and consistency of data. The manipulation of data through coding and classification of patient information presents a critical process where the quality of information, as well as perceived quality of care, could potentially suffer. Where recent regulatory standards, such as HIPAA, create additional requirements for consistency in coding of health information, it becomes apparent that meaningful health outcomes assessment is, in part, an indicator of data quality as well as clinical quality. In a national survey of 16,000+ accredited health information managers we found most respondents reported that significant coding errors existed in 5% or less of the records in their institutions. Within specific organizations, however, coding errors existed in six to ten percent of their records, and at times exceeded 20%. Regional variation in reported coding error and inconsistency ranged widely, occurring across organizations as well as population concentrations. Metropolitan-based organizations tended to have somewhat worse reported overall coding accuracy, compared to suburban and rural areas. At a national level there will need to be some degree of coding and classification uniformity across population areas, if healthcare professionals are expected to rely on comparative evidence benchmarks to fully assess medical outcomes data. Related impacts on comparative cost and clinical performance assessment are discussed.

Incremental Adoption of Information Security in Health-Care Organizations: Implications for Document Management

The incremental adoption of electronic media in U.S. health care has created increased risk of security and privacy violations in provider organizations. Protective regulatory efforts have been proposed to address ineffective security of patient information, with severe noncompliance penalties. Using data from a nationwide survey of health information managers, this study examines how industry-wide knowledge management trends may influence the degree of security program adoption in health-care organizations. Results suggest that significant nonadoption of mandated security measures continues to occur across the health-care industry. Paper-based systems still prevail, and computerized settings tend to have less security measures. Implications for document management and knowledge policy are discussed.