Hospitals that have received Medicare incentive payments for electronic health record use have not fully implemented all of the fraud safeguards recommended by ONC, according to a report from HHS' Office of the Inspector General.
In 2006, ONC contracted with nonprofit consulting firm RTI International to develop 14 recommendations to enhance data protection, validity, accuracy and integrity as well as strengthen fraud protection in EHR systems. To determine the extent to which these recommendations are being followed, OIG issued an online questionnaire to the 864 hospitals that received Medicare incentive payments as of March 2012, conducted on-site interviews at eight hospitals and surveyed four EHR vendors about how they incorporate ONC's recommendations into their products.
Results showed the following:
- Nearly all hospitals have the recommended audit functions in place, but many are not fully using them.
- All hospitals reported authenticating EHR uses with unique usernames and passwords, and 98 percent have implemented automatic user log-offs following a set period of time.
- A majority (88 percent) of hospitals have limits on which users can export, send or print data, though only 27 percent require a user to provide a reason for doing so.
- Just 43 percent of hospitals reporting allowing patients to see their EHR data, which the ONC recommends to help identify errors and potential fraud.
- The most pressing issue found by the OIG was the use of copy-paste features in EHRs, which can facilitate attempts to duplicate records or create fraudulent claims. The investigation found only 24 percent of hospitals have policies in place to monitor the use of copy-paste technology, and only 44 percent of hospital audit logs record the method of EHR data entry.
The OIG recommends ONC and CMS strengthen their collaboration to develop a plan to address fraud and other vulnerabilities in EHRs.
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