04/20 2012

The problem of inaccurate clinical supply documentation

At a recent HIMSS conference last month, I co-presented at a Supply Chain Special Interest Group session regarding the problem of poor clinical supply documentation accuracy at the point of care and its implications for hospitals’ financial/risk management and quality of patient care. The goal of this meeting was to create awareness in the healthcare IT community around these issues and to ensure that as more organizations implement EMR systems, we don’t forget the basics – making sure that there’s integrity in the data that ends up in the EMR.

These problems are particularly common in specialty procedure areas (OR, EP, IR, cath labs), which are heavy users of implantable and consumable medical devices. Although many of these specialty procedures would clearly not be possible without such devices (which tend to be extremely costly), when it comes to their proper management, documentation, and tracking, the industry lacks any efficiency and automation, resulting in an estimated waste of at least 5 billion dollars in implantable devices alone (just in the U.S.), between providers and manufacturers.

In a three-month study of an endovascular OR that VUEMED conducted, we found that 100% of documented patient cases had at least one documentation error, most involving both under-billing and over-billing issues.  Errors included documenting wrong products, recording wrong quantities, failing to document products as used, documenting products as used when they weren’t, and applying wrong billing and reimbursement codes.  And that’s the kind of data that ends up in a patient’s EMR. In addition to errors, the recorded information was missing critical details such as the products’ lot and/or serial numbers and expiration dates, making it nearly impossible to track a recalled item or ensure that an expired product isn’t used on a patient.

Needless to say, the implications of these errors are significant not only for financial reasons (hospitals don’t have a full picture of their actual costs, potential unintentional fraud to payers, etc.), but also for patient clinical quality reasons (erroneous patient records, risk of using a recalled or expired item in a patient, difficulty in correlating the use of a particular device to patient outcomes, etc.). Although these kinds of errors are a daily reality for many institutions, I see things beginning to change for both hospitals and manufacturers, which are increasingly recognizing that accurate point of care data is a key element of clinical quality, financial health, and risk management.