The information quality theme consists of accuracy and timeliness of data subthemes. The information quality dimension of DMISS refers to the accuracy and timeliness attribute of data that a healthcare provider can enhance to store patient information (Petter et al., 2013). The data accuracy and timeliness subthemes emerged from the participants' strategies to improve EHR information quality.
Accuracy. EHR's improved accuracy and timeliness of data avail up-to-date information to physicians for making informed decisions during patient care (Deokar & Sarnikar, 2016). P1 and P4 stated that for accurate data, the health information
management (HIM) department team checks patient records for incomplete
documentation by reviewing charts before and after patient discharge. P2 asserted that IT system configuration settings promote accuracy such as the use of drop-down menus and best practice alerts to help providers make the right decisions. P3 shared that EHR built- in features help to identify inconsistent data such as comparing cities to zip codes, male to female codes and temperature ranges.
P4 indicated that the strategy for ensuring accurate data starts at the registration, by crosschecking patient identification information to avoid identity theft. A two-person team verifies patient identification during medication by using patient name and date of birth to ensure the accuracy. P4 added that a data integrity team identifies and resolves patient information duplicates, overlays, and inconsistencies. P5 stated that auditing
reports help in medical record deficiency and delinquency management by generating automated notifications to providers to rectify incomplete records. P5 described a multi- modal audit approach where automated audits highlight patterns of inconsistent
documentation, and then manual audits confirm the deviation from documentation best practice.
I examined a Patient Identification SAFER Guide document that includes safety practices associated with the reliable identification of patients in the EHR by a two- person team, using patient’s name, date of birth, and gender. The two-person verification strategy in the document confirmed the strategy that P4 described for the confirmation of patient identity based on patient name and date of birth. The document includes a strategy to use EHR auditing reports to identify duplicate patient records, which confirmed the strategy that P4 and P5 mentioned for identifying and merging duplicate records. In the document, a strategy for assigning each patient a permanent identification number to prevent duplicate records confirmed P4's strategy for preventing patient information duplicates and overlays.
Timeliness. Physicians access and update the EHR through secure software and hardware to ensure timeliness (Helton et al., 2017). For data timeliness, P1 stated that care providers have access to computers on wheels (COWS) that they wheel in and out of the patients' rooms to document in front of the patient. P1 added that physicians use their phones for dictation capability to document patients’ encounter directly into the EHR system. P1 mentioned EHR's shorthand capability for recognizing smart phrases to populate full text helps the physicians to facilitate timely and complete documentation.
Real-time data entry of patient medical care results in up-to-date EHR (Colonias et al., 2017). For timely and up-to-date patient information, P4 reported that hospital policy requires the physicians to provide timely documentation in the EHR after a patient encounter. On the inpatient side, certain elements must be complete within 24 hours, while the outpatient providers have to document within 72 hours.
I examined a General Policy for Documentation in EHR document that lists data elements that must be accurate, relevant, timely, and complete. The policy in the
document confirmed the strategy that P4 described for providers' timely and accurate documentation in the EHR after each patient encounter. The document includes a strategy to ensure health records contain patient identification, diagnoses, treatment, results of treatment, patient discharge status, and plan of follow-up care. The strategy confirmed the processes provided by P4 for ensuring complete health records.
The participants’ interview testimonials are as follows: "When our clinical decisions people in the HIM department look at that data, they are looking for any gaps of what might not have been documented" (P1). "There are things within our system that we can configure to help with accuracy. IT team uses a lot of drop-down menus, so we are limiting what they can enter" (P2). "We allow our physicians to use their phone as a dictation device to indicate what is going on with the patient" (P1). "We generate automated notifications to the provider which create automated emails that state, 'You have documentation that is overdue'" (P5).
Table 2 includes the subthemes that emerged from the data analysis regarding the strategies to ensure information quality by improving data accuracy and timeliness. The
data accuracy and timeliness strategies that emerged from the data analysis were (a) teams to verify data, (b) accurate documentation, (c) dictation capabilities, and (d) audit for record completeness.
Table 2
Theme 1: Information Quality Coding Frequency
Word Count
Accuracy 18
Timeliness 9
The information quality theme from the findings links to existing literature on effective business practice. The information quality theme consists of accuracy and timeliness of data subthemes. The accuracy and timeliness of data in EHR result in up-to- date information that clinicians use for making informed decisions during patient care (Deokar & Sarnikar, 2016). Healthcare providers rely on the accuracy and timeliness of EHR data to bolster efficiency, improve patient care and lower costs (Tsai et al., 2014). Accurate and timely data results in reduced medical errors, which improves patient safety, promotes patient satisfaction, and reduces costs for the hospital (Deokar &
Sarnikar, 2016). The findings of this study included the IT leaders' strategy to ensure data accuracy by checking patient records for incomplete documentation in patients’ charts. In addition, the clinicians enter data in real time from workstations, tablets, and smartphones as a strategy for timely data.
The information quality dimension of DMISS conceptual framework refers to the accuracy and timeliness attribute of data that a healthcare provider can enhance to store
patient information (Petter et al., 2013). The information quality theme from the findings links to the information quality dimension of the conceptual framework in that IT leaders use strategies to improve the accuracy and the timeliness of EHR data to ensure
information quality. For accurate data, the IT staff checks for incomplete documentation by reviewing patient charts. For timely data, clinicians have access to EHR from
workstations, tablets, and smartphones. The leaders enforce a timeliness policy for the physicians to complete documentation within 72 hours of a patient encounter.