Patients Listed Alive in Electronic Health Records Were Actually Deceased: Study

Specific unnecessary interactions called out: appointments, medication orders.

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Hundreds of deceased patients are incorrectly listed as alive and receiving unnecessary medical interventions, according to a recent study.

About one in five seriously ill patients’ records did not reflect their actual deceased status, researchers from the University of California at Los Angeles found. Instead, these ghosts-in-the-system overburdened health care workers with unnecessary prescription refills and strained already limited resources.

With administrative inefficiencies already under heavy criticism, this study illuminates yet another way limited mortality data distorts an overtaxed health care system.

Wasted Health Care Resources

The findings were published in a JAMA Internal Medicine research letter by Dr. Neil Wenger, professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

Dr. Wenger and his team tracked 11,698 seriously ill patients aged 18 years and older throughout 41 UCLA health clinics for two years or until November 2022, whichever was earlier. They compared the electronic health records of patients noted as living against death data from the California Department of Public Health’s Death File, much of it confirmed by hand. This file contains identifying information such as the deceased’s name, sex, and birthday.

Of all patients, 2,920 were correctly noted as deceased in their health records. However, 676 were wrongly documented as still alive when, according to the CDPH’s death file, they had died.

Of these 676 deceased patients, 541 individuals, or 80 percent, still had appointments pending in the UCLA health system. Additionally:

• 221 deceased patients received 920 letters about preventative care measures like flu shots or cancer screenings
• 166 received 226 mailed correspondences
• 158 had 184 orders placed for vaccines and other care
• Medications were authorized for 130 of the deceased individuals
• Among 145 patients, 310 medical appointments were still listed as active

The Different Costs of Data Gaps

The gap in accurate mortality data exists partly due to a California law that restricts full death record access to law enforcement for fraud prevention, according to the authors. The limited information provided to health care facilities often lacks enough patient specifics to definitively confirm deaths. The only other option for real-time mortality data is the National Association for Public Health Statistics and Information Systems. However, health care systems have not traditionally had access.

“Not knowing who is dead hinders efficient health management, billing, advanced illness interventions and measurement,” the authors wrote. “It impedes the health system’s ability to learn from adverse outcomes, to implement quality improvement and to provide support for families.”

A 2021 study by McKinsey, a management consulting firm, estimates U.S. hospital administrative costs at roughly $250 billion nationwide, while clinical services administration totals $205 billion—representing 21 and 27 percent of national health care spending.

Research from 2014, published in the Health Affairs journal, found that other nations spend 42 percent less on hospital administration than the U.S. One estimate suggests the U.S. spends $1,055 per capita on health care administration, the highest amount in the world. For comparison, the second highest is Germany’s—at $306 per person.

The researchers note this data disconnect may not be applicable to other health care systems or states.

Embracing Electronic Health Records

Electronic health records have been the standard of care since their widespread adoption began in 2015. They are, essentially, a digital version of a patient’s medical history maintained by one or multiple health care providers over time. They typically contain all key clinical information relevant to a patient. This includes demographics, progress notes, health issues, medications, vital signs, medical history, immunizations, lab test results, and radiology reports.

Electronic health records have become the standard because they enhance patient care in the following ways:

• Enhancing the precision and clarity of medical records to minimize medical errors
• Making health information readily available across health clinics or within a Health Maintenance Organization (HMO)
• Keeping patients informed to make better decisions