Patient characteristics and health system encounters of decedents not marked deceased in the electronic health record.

Objectives: Health systems are increasingly accountable for patients and require accurate electronic health record (EHR) vital status. We recently demonstrated that 19% of seriously ill primary care patients in one system were not marked dead in the EHR and 80% of these decedents had an encounter or appointment outstanding after death. Herein we describe the mechanism of identifying decedents whose death is not captured at the level of the EHR, characterize these decedents, and describe medications refilled after death. Materials and Methods: Description of multistep process to identify deceased patients not marked dead in the EHR among a cohort of seriously ill primary care patients including public death file matching, utilization analysis, and chart abstraction. We compared decedents not marked dead in the EHR to known decedents and described pharmacy requests and refills. Results: Nearly 90% of encounters and appointments occurred because the health system EHR did not record the death although 11% of these encounters contained condolences or death notifications. Decedents not marked dead in the EHR were older and lived in more vulnerable areas than those marked dead. Of 146 refill requests after death, 88 medications were authorized. Discussion and Conclusion: Matching with a limited public death file is an inadequate solution to inaccurate vital status. Better workflows are needed to capture deaths about which clinicians and staff are aware, but will identify only a fraction of the decedents inaccurately listed as alive. Efforts are needed to connect EHRs with more specific sources of linkable decedent information.