Can You Trust Your Data? The Challenge of EHR Data Integrity

In revenue cycle management, certain dates should be absolute. Date of service, payment posting dates, and other key data points should never change once recorded. Yet, the reality of EHR data integrity often falls short of this expectation, creating serious challenges for healthcare organizations and medical billing companies alike.

When Unchangeable Dates… Change

Let’s examine a real-world example that highlights critical EHR data integrity issues. Consider a basic payment posting scenario:

• January 3rd: You post a $100 payment for a claim
• February 5th: You post an additional $200 payment for the same claim

Logically, both transactions should remain in your system as separate entries with their respective dates. This seemingly simple data point—when a payment was posted—should be permanent and unchangeable.

However, in systems like Kareo, something bizarre happens: the later payment date can overwrite the earlier one. This “time travel” retroactively changes historical data, essentially rewriting what should be immutable records.

The Business Impact of Poor EHR Data Integrity

This seemingly technical issue creates significant business problems:

1. Inaccurate reporting: If February payments retroactively record as January payments, your monthly collection reports become unreliable. When February shows lower collections than reality, both operational decisions and client billing can be affected.
2. Inconsistent historical data: Running the same report on different dates yields different results—not because new data was added, but because historical data was altered. A January collection report run on February 1st might show $100,000, but the same report run on March 1st might show only $98,000.
3. Audit challenges: When clients or auditors review historical data, discrepancies between your reported figures and what appears in the system can create serious trust issues or even allegations of impropriety.

According to healthcare data management statistics from HIMSS, 47% of healthcare organizations report significant challenges with data consistency across their various healthcare IT systems.

Beyond Kareo: An Industry-Wide Problem

While our example focuses on Kareo, this issue is not unique to one vendor. Many practice management and EHR systems suffer from similar EHR data integrity problems. The causes vary:

• Poor database design
• Misguided attempts to “simplify” historical data
• Legacy code that wasn’t properly tested
• Confusion between transaction records and status records

As noted in our article on RCM analytics, these data inconsistencies create significant barriers to meaningful analysis and performance improvement.

The Solution: Creating a System of Record

If you can’t trust your EHR or practice management system’s data, what’s the solution? Creating an independent system of record with proper EHR data integrity should be your priority:

1. Extract raw transaction data daily: Pull charges, payments, ERAs, and other critical transaction records from your EHR/PM system on a regular basis.
2. Maintain independent storage: Store this data in your own data warehouse where it remains immutable.
3. Implement proper data governance: Ensure your system maintains change records and audit trails.

While Medical Economics reports that implementing proper data governance processes can reduce data inconsistencies by up to 82%, many organizations still struggle with these foundational elements.

Addressing the Mismatch Challenge

One inevitable challenge with this approach is that your system of record may not match the source system. When your EHR retroactively changes historical data, discrepancies will appear.

This is actually desirable! Your system should maintain data integrity even when the source system doesn’t. When discrepancies occur:

1. Document the inconsistency
2. Identify the pattern of change in the source system
3. Develop a clear explanation you can provide to stakeholders
4. Use your system of record for official reporting and analysis

For organizations managing multiple medical billing dashboards, having a single source of truth becomes even more critical for consistent decision-making.

Taking Control of Your Data

The lesson is clear: EHR data integrity cannot be taken for granted. Even data points that should never change sometimes do, and blindly trusting your EHR or practice management system can lead to significant business problems.

By extracting and storing raw transaction data in your own system, you create a trustworthy foundation for:

• Accurate month-to-month reporting
• Reliable client billing
• Confident responses to audits
• Meaningful performance analysis

Don’t wait until data inconsistencies create business problems. Implement a proper system of record today, and ensure your organization’s decisions are based on data you can truly trust.