What’s the Future of Health Information “Disposal”?

While at the HIM Summit, Deborah Green from AHIMA talked about the information lifecycle in healthcare. She showed a number of representations and flow charts of how information is collected and used in healthcare. Although, the part of the chart that intrigued me the most was the “disposal” element at the end. In fact, it prompted me to tweet the following:


As you look back at history disposal of paper charts was pretty straightforward. Most of the charts were organized by year and so you could have a 6 year retention policy. You’d collect all the charts that were older than 6 years and then either shred the old charts or move them to a more long term storage facility.

This concept gets much murkier in the world of EHR and digital charts. In fact, I talked with Deborah after her talk and asked if they’ve ever seen an EHR vendor which had a feature that would allow them to digitally “dispose” of an electronic chart. I’ve talked to hundreds of EHR vendors and I’ve never seen such a feature.

As a tech guy, I’ll admit that I wouldn’t want to be the programmer responsible for writing the code that “disposes” of an electronic chart. EHR software has been coded to never delete anything. At a maximum it might mark a record as inactive or essentially hide a record, but very few things in an EHR are ever really deleted. The concept of deletion is scary and has lots of consequences. Plus, what happens if your algorithm to delete old charts goes wrong and deletes the wrong information? You can fix that with some great backups, but I can imagine a lot of scenarios where even the backup could fail.

Technical challenges of an EHR delete feature aside, what does the future of digital chart “disposal” look like? What should digital chart disposal look like? Do we “shred” digital charts? Do we “shred” part of them? Do we keep them forever?

The reality is that the decision of what to do with the electronic chart is also dependent on the culture of the hospital. Research organizations want to keep all of the data forever and never ever delete anything. That old data might be a benefit to their research. Rural organizations often want to keep their data as long as possible as well. The idea of deleting their friends and neighbors data is foreign to them. In a larger urban area many organizations want to dispose of the chart as soon as the retention requirements are met. Having the old chart is a liability to them. Not having the chart helps remove that liability from their organization. Those are a few, but EHR vendors are going to have to deal with the wide variety of requirements.

If you think of the bigger picture, what’s the consequence if we shred something that could benefit the patient later? Will we need all of the historical patient information in order to provide a patient the best care possible?

These are challenging issues and I don’t think EHR vendors have really tackled them. This is largely because most organizations haven’t had an EHR long enough that they’re ready to start purging digital charts. However, that day is fast approaching. It will be interesting to see the wide variety of requests that organizations make when it comes to disposing of digital charts. It will also be interesting to see how EHR vendors implement these requests.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

1 Comment

  • John, some great points. I believe that the day of trashing old records should be in the past. As you pointed out, historical data of illness and treatment offers great info for research purposes if de-identified, for instance. Plus if some patient comes back years later, or requests come for old records for a long gone patient, you’ve got to have them to provide them. Sure, you can archive them in a separate database – as long as they can easily be retrieved. But delete, no way!

    Ron

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