Data gaps in EHRs must be addressed, not discounted

I'm often cynical about studies that seem flawed, misleading, or not useful. But sometimes a study that seems off the mark or outdated can actually be significant.

Last week, a study published in the Journal of the American Medical Informatics Association (JAMIA) took some flak on the Internet. It found that EHRs are missing a "substantial" amount of data, which could have "profound" implications for clinical care, medical research and public health.

The researchers reviewed the electronic health records of 5,500 patients being treated by a particular multi-specialty group who were diagnosed with either bipolar disorder or depression, and found that the EHRs were missing a lot of clinical data about the patients' behavioral healthcare. For instance, more than half of behavioral health visits were not recorded in the EHR; almost 90 percent of acute psychiatric services at hospitals also were missing.

The study has been criticized for several reasons, including the fact that the data is from 2009, that it only reviewed two specialty diagnoses; that behavioral health providers in 2009 likely wouldn't have had EHRs to exchange data with primary care providers; and that the study is limited because it only involved one insurer and one EHR.

Critics, however, are missing the point. 

It doesn't matter whether the data comes from one insurer, one provider group or from 2009. The point is that in 2016, we still don't have patient records that are complete. Behavioral health treatment still is not integrated into physical health records. Patients are withholding information from doctors. Claims information is incomplete. We still don't have robust interoperability. Providers aren't routinely checking health information exchanges to supplement their records. And even if they query an HIE, it may not hold any information on that patient. Data is still siloed, even if the silos are larger.

The truth is that gaps exist in the information in the EHRs. While gaps are not new--as critics point out--it was hoped that EHRs would consolidate the data and reduce those gaps. That's not occurring.

The most complete record is still in a patient's memory. After all these years of EHRs, we've made little progress in this area.

It may be less problematic for a primary care physician to know that a patient went to the ophthalmologist for a new eyeglasses prescription. But this takes on new meaning when dealing with comorbidities or conditions, like diabetes, which requires a team of specialists to treat. Or what triggered that depressive episode? That multiple sclerosis diagnosis? A death in the family? It might really help that primary care provider to know this type of information and include it in the EHR.

How can the healthcare industry properly coordinate care without knowing what the care was?

Perhaps the best aspect of this study is that it should spark discussions about what's not working and how EHRs could be used more effectively to close the gaps. Should patients be incentivized to complete personal health records? Doctors required to directly ask patients of care received since the last visit?  Coordinate and consolidate patient records under those unique patient identifiers? Require all patients to have a primary care provider or be part of a patient centered medical home?

If we address the issue, we may come closer to resolving it. - Marla (@MarlaHirsch and @FierceHealthIT)