In other words, when patients receive medical care and services outside their primary clinic, the action may not be captured electronically at all or, if it is, it is captured by a system that doesn't communicate well with the clinic's system. Medication errors are likely occurring frequently because many actions related to patient medication take place somewhere other than the primary clinic, the report said.

"Individuals frequently receive specialty care at other locations which do not (and usually cannot) share data with that [clinic's] EHR. Computer decision support systems in EHRs are intended to protect patients at the time of prescription by guiding drug selection and dosing, and alerting physicians about dangerous drug-drug or drug-disease interactions. However, increased physician reliance on computer decision support in the present context of fragmentation and incomplete data may lead to poor-quality care and medical injury."

The authors laid most of the blame at the feet of government regulators and EHR vendors.  

"Better interoperability could be facilitated with national technical standards. Federal policies to date have tilted too far in accommodating EHRs vendors' desire for flexible, voluntary standards. The incompatible products that result undermine public health goals and can lock providers in to proprietary systems that cannot easily share data," the study said.

The medical profession should respond quickly to this gap between claims and records, the researchers argued, since "missing clinical information raises concerns about medical errors and research integrity. Given the fragmentation of health care and poor EHR interoperability, information exchange, and usability, priorities for further investment in health IT will need thoughtful reconsideration."