Nearly 20% of deceased patients listed as alive in electronic health record

Key takeaways:

• Researchers identified 676 patients at an academic health care system who were deceased but listed as alive.
• More than 900 letters about unmet preventive care needs were sent to unmarked deceased patients.

Nearly 20% of deceased patients in a Californian health care system were marked as alive with a serious illness in the electronic health record, resulting in hundreds of unnecessary outreach efforts, according to researchers.

“The amazing thing is that this is an easily solvable problem because the state has a database that can identify most of the patients who die, but current law prevents them from giving it to health care institutions; only financial institutions,” Neil S. Wenger, MD, MPH, a professor at the University of California, Los Angeles (UCLA), said in a press release.

Wenger and colleagues wrote in JAMA Network Open that electronic health records often do not reflect death, leading them to investigate the proportion of active patients who are not known to be deceased by the records.

To do this, they examined EHRs of 11,698 seriously ill patients across 41 primary care clinics affiliated with UCLA who were followed for 2 years or until November 2022. Wenger and colleagues then compared the alive cohort according to the EHR against the California Department of Public Health Public Use (CDPH) Death File.

Among all patients, 2,920 (25%) were marked as deceased in the EHR, whereas 676 (5.8%) were marked as deceased in the CDPH Death File but marked alive in the EHR.

Overall, 80% of patients who were not known to be deceased had an outstanding appointment or encounter. These patients received 338 portal messages and 221 telephone calls.

The researchers also noted that, among deceased patients:

• 221 received 920 letters regarding unmet preventive care needs;
• 166 received 226 other mailed correspondence; and
• 158 had 184 orders placed for vaccines and other care.

Additionally, 88 medications were authorized in 130 encounters, and 145 patients had 310 active appointments after death.

“In total, 7,469 days elapsed between the date of death and the date of cancellation or no-show,” the researchers wrote.

Not knowing which patients are deceased “hinders efficient health management, billing, advanced illness interventions, and measurement,” Wenger and colleagues wrote.

“It impedes the health system’s ability to learn from adverse outcomes, to implement quality improvement, and to provide support for families,” they wrote.

There were several limitations to the study, according to the researchers. For example, it was conducted in a single health system and thus possibly not applicable to other systems or states. In addition, the follow-up period was “modest,” Wenger and colleagues wrote.

“Perhaps highlighting this problem will raise awareness and help to fix this issue,” Wenger said.

References:

• About 20% of patients listed as alive in their electronic health records were actually deceased according to California data. https://www.eurekalert.org/news-releases/1009795. Published Dec. 4, 2023. Accessed Dec. 6, 2023.
• Wenger N, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.6428.