Lost Diagnoses and Chart Lore—The Hidden Failures of the EHR

“A well-structured chart benefits all care models—fee-for-service, value-based care, or direct care. Good medical information management transcends billing systems.”

Diagnoses Shouldn’t Just Vanish—But They Do.

Imagine this: a patient has a critical diagnosis documented by their physician, and somehow, months or years later, it’s gone from the chart. No trace. No explanation. It’s as if the diagnosis never existed.

Now flip the scenario:

A patient gets misdiagnosed or has a condition that was ruled out, but the diagnosis sticks in the chart like glue. It’s copied forward from note to note, reappearing in consults and discharge summaries, becoming what we call chart lore—data that’s assumed to be true simply because it’s been there so long.

These aren’t isolated events. They’re symptoms of a broken system.

The Real Problem: EHRs Were Never Built to Manage Clinical Information

EHRs were designed around encounters and billing, not around the lifelong management of clinical information. Diagnoses are often tied to a single visit or problem list update, rather than being treated as dynamic, evolving components of the patient’s health history.

When we shifted to value-based care and started relying on accurate, persistent diagnoses (like HCC codes), the failures of the system became obvious. But the cracks were always there.

Here’s the truth:

💡 If EHRs had been designed to properly capture, store, and retrieve clinical information, we wouldn’t be scrambling to solve these issues today.

💡 A well-structured chart benefits all care models—fee-for-service, value-based care, or direct care. Good medical information management transcends billing systems.

The Consequences: What Happens When Diagnoses Are Lost (or Stick Around Too Long)?

1. Missed Care Opportunities: When diagnoses disappear, critical conditions can go untreated. Patients lose continuity, and clinicians waste time rediscovering the same issues.

2. Harmful Chart Lore: Erroneous diagnoses that persist in the chart can lead to unnecessary treatments, patient confusion, and miscommunication among providers.

3. Administrative Headaches: We’re now dependent on external tools and companies to “resurface” lost diagnoses or flag suspected ones—something the EHR should handle by default.

It’s Time to Rebuild the Chart Around Clinical Logic

If the medical chart were designed around clinical reasoning instead of billing, none of this would be an issue. Diagnoses wouldn’t disappear, and they wouldn’t become erroneous chart lore. They’d be dynamic, tracked, and organized based on the patient’s evolving health—not the payment model.

It’s time to stop patching holes in a broken system and start building a chart that supports accurate, meaningful clinical information from the ground up. Because isn’t it crazy that a doctor’s work—a diagnosis—could be lost? Or worse, wrong, and nobody knows it?