Orientation Schedule Office Staff Update Schedule

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1 First Quarter 2010 is YOUR OFFICE READY FOR THE TRANSITION TO electronic MEDICAL RECORDS? By: Maryann Wee, RN, Assistant Director of Risk Management and Beth Easley, RHIA, Senior Risk Management Consultant The key to evaluating the myriad of electronic medical records (EMR) systems available and having a successful transition to your chosen electronic system is knowing the strengths and weaknesses of your current office systems. It is important for you to select the system that has the right fit for your practice. However keeping up with the day-today problems encountered in running a busy medical practice does not leave physicians and their staff any time for evaluating a practice. Your practice may not be a well-designed one from the risk management purview. You may not even be aware of it. These types of physician offices will likely have implementation that is flawed. If this is the case, you may waste not only the money invested in the system, but you will likely also exhaust and misuse time, energy and effort. The MACM Risk Management Department can help. We have a time tested medical office survey which will evaluate the following areas of your practice: De v e l o p i n g c o n s i s t e n c y o f d o c u m e n t a t i o n a n d s y s t e m s among the clinic s physicians and their staff. Electronic medical record systems require agreement among all members of the clinic on how information will be documented and what systems will be utilized to track this information. Does every physician in your practice have their own way of doing things? Who has the best systems in the practice and what can the rest of the clinic learn from them? Kn o w w h a t s y s t e m s a r e c u r r e n t ly b e i n g u s e d t o t r a c k m i s s ed a p p o i n t m e n t s, d i a g n o s t i c t e s t i n g r e s u lt s a n d in this issue 2 Maples Musings r e f e r r a l s t o o t h e r p h y s i c i a n s a n d if t h e s e s y s t e m s a r e w o r k i n g. What is working well in your office and can that be incorporated into the EMR system you are evaluating? What can the EMR system offer that will improve your current systems? Do c u m e n t i n g a c o m p r e h e n s i v e l i s t o f t h e pa t i e n t s medications/allergies which includes all the necess a r y i n f o r m a t i o n a n d r e c o n c i l i n g t h i s l i s t o n e v e r y v i s i t. The medication sections of most EMR systems are invaluable in recognizing and alerting staff to possible drug interactions and allergy problems, but to perform this function, complete data has to be entered on every encounter. How consistent and complete is your staff s documentation of medication? At the end of the survey, your office will receive a written report which scores the strengths and weakness of documentation and office systems by provider and offers recommendations on how to improve the weak areas. Consultants are also available to sit down and review the findings with either individual providers or the whole clinic. An added benefit of the survey is it will also look at patient safety and risk management issues that can improve patient care and reduce your liability risks. Remember all the above services are provide free of charge as a benefit of your being insured by MACM. If you are interested in a survey, please contact the Risk Management Department at rskmgt@macm.net Office Staff Update Schedule Orientation Schedule

2 Maples Musings Conflicts of interest Michael D. Maples, MD, Medical Director How do you deal with conflicts of interest? In my professional life, I never gave much thought to conflicts of interest until I came to MACM. Most of the physicians I came into contact with seemed to me to have no conflict. They did what was best for the patient and they made money for doing that. Actually, more money than most people. I knew there were doctors in the hinterlands ordering multiple non-indicated tests and scamming Medicare, Medicaid and insurance companies, but I did not know them. [That is not entirely true as I did subsequently learn of some of my acquaintances and classmates who did commit such crimes.] But, at the time, I did not know them. My point is that the doctors who were reared by moral people and trained by moral people did not have conflicts of interest related to patient care. Most of us deal with conflicts on a daily basis. If I do this procedure or if I order this medicine will it help this patient; will it hurt this patient? We do not always consider the effect on us as physicians. Training at home and training in the hospital ultimately determines whether these conflicts are resolved in favor of the patient. I have met a physician whom I considered an anathema to the profession. He did what was in his best interest first and he did not even realize it. My conversation began with his bragging that he had never lost a patient following an appendectomy. I was a board certified general surgeon at the time and knowing the natural history, especially in the elderly, I found this quite remarkable. The rest of the story was revealing in many ways. He had completed a rotating internship and had set out in private practice. During his long career he had simply refused to operate on anyone who was very sick and he deemed was at risk of dying. Morphine and a quiet room were his treatments. As a general surgeon, I knew that those were precisely the patients who could be helped the most. In his estimation, it was better for the patients to die of natural causes than to have an operation and die and thereby mar his record. Who knows, in the end and in his hands, he may have been correct but I could not abide that cynical thought. This doctor did not even realize he had a conflict. He viewed medicine as a way to make a living only; he had no other mission. He thought that by never having lost an appendectomy patient he would have more surgical cases referred to him. He said that. Real and potential conflicts of interest seem to pervade medicine today; drug companies and device companies; doctor owned facilities and doctor-driven procedures. Still I would submit that a morally upright and well trained physician is the best hope that a patient has. I do not think that hospital administrators or drug company stockholders have the patient s interests first. MACM insured physicians are our primary focus. You are our patient for whom we want no conflict of interest. MACM goes around the world, metaphorically, to make sure your interests are primary. That is partly because we are a doctor-owned company and partly because the administration, including Mike Houpt and Rob Jones, Esq., demands it. Lawyers and the slimy underbelly of life will teach you a lot about conflicts of interest. It has been a useful education for me to hear how and what the Company does to try to make sure that our insured doctors have representation that has the doctor s interest as primary and sole. We at MACM go way out of our way to see that, if one of our doctors is sued, he is represented by a qualified, dedicated, unconflicted counsel. To complete the circle you should now try to determine if I have a conflict of interest by writing this Musing. I work for MACM and you. I receive a salary from MACM. Do I have a conflict or do my words ring true based on your own experience and understanding? 2

3 2010 Office Staff Program: The Silver Tsunami is Coming Are You Ready? A giant wave of older patients is headed your way! Why? The Baby Boomers will be turning 65. The first large wave is expected in 2011 and the wave will peak in So what does this mean for your clinic? It means more patients with more chronic diseases requiring more time and more resources. Along with these challenges, there are increasing liability issues when dealing with an aging patient population. Medical Assurance Company of Mississippi claims experience over the last 10 years has shown that the majority of lawsuits are initiated by claimants between the ages of years of age (35 percent), the second highest age group for initiation of lawsuits is over the age of 60 (27 percent). So what can you do to keep from being swept away? The 2010 MACM Office Staff Program will focus on the issues of the aging patient population and steps you can take to keep your head above water. And by the way pediatric clinics you are not immune to this! Children have parents and grandparents! And, we all have family members that are aging. This program is for physicians, office managers, nurses, medical assistants, and any staff you feel would benefit from this information. Schedule S10-3 March 25, 2010 Gulfport S10-4 April 6, 2010 Tupelo S10-5 May 20, 2010 Hattiesburg S10-6 June 24, 2010 McComb S10-7 July 22, 2010 Oxford S10-8 August 19, 2010 Columbus Wingate Inn S10-9 September 16, 2010 Greenville Delta Regional Medical Center S10-10 September 30, 2010 Gautier S10-11 October 19, 2010 Jackson Courtyard by Marriott (Highway 90) Bancorp South Conference Center Lake Terrace Convention Center Southwest MS Regional Medical Center Oxford Conference Center Gautier Community Center Mississippi Agriculture and Forestry Museum (Forestry Auditorium) Please register each individual from your clinic that wishes to attend the meeting. You may substitute registrations if needed. Any cancellation must be received prior to the day of the program. Cancellations the same day of the program or noshows will generate a $10 invoice per person (to cover the expense of the lunch) to the MACM-insured physician. Attendee Name (1): Attendee Name (2): Attendee Name (3): Physician/Clinic Address: Phone: Fax: I wish to register for Program Number: Place: Date: You will receive a written confirmation from the Risk Management Department to confirm attendance. If you do not receive a confirmation from the Risk Management Department within two weeks of the meeting date, please resubmit. A fax or reminder will be sent to you approximately two weeks before each program. Fax registration to: MACM Risk Management Department at (601)

4 MANDATORY ORIENTATION PROGRAM FOR NEW PHYSICIANS GUIDELINES New physicians whose policy effective date begins January 1, 2009 or later, have one year from the month of policy inception to complete this requirement, e.g., if policy effective date is March 5, 2009, the new physician must complete the requirement by March 31, Failure to attend one of the programs scheduled within your one year time frame will result in a 5 percent premium surcharge or $1000, whichever is greater. Continued failure to attend through the next policy period will result in a 10 percent surcharge or $1000, whichever is greater. If the requirement is not met within the third policy period, the physician will be considered for non-renewal. To Receive Credit for Attendance, Physicians Must Be Present for Entire Two-Hour Program. CME CREDIT Medical Assurance Company of Mississippi is accredited by the Mississippi State Medical Association to provide CME for physicians. MACM takes full responsibility for the content, quality, and scientific integrity of this activity. MACM accepts no commercial support for its CME activities. Medical Assurance Company of Mississippi designates the Risk Management portion of this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should only claim credit commensurate with the extent of their participation in the activity. Evening Programs: Registration and hors d oeuvres from 5:30 6:00 pm; Program from 6:00 8:00 pm Luncheon Program: Registration and lunch from 11:30 a m 12 n o o n; Program from 12 n o o n 2:00 pm 2010 Schedule N10-2 March 30, :30 pm 8:00 pm Oxford Baptist Cancer Institute N10-3 April 13, :30 pm 8:00 pm Hattiesburg Forrest General Hospital N10-4 June 22, :30 pm 8:00 pm Biloxi Biloxi Regional Medical Center N10-5 August 26, :30 am 2:00 pm Jackson UMMC Student Union N10-6 September 21, :30 pm 8:00 pm Tupelo North Mississippi Medical Center N10-7 October 28, :30 pm 8:00 pm Jackson UMMC Student Union Clinic Managers are invited to accompany their physicians. Please be sure to register. We strongly encourage new physicians to attend one of our programs at their earliest opportunity. If you do not receive a fax or letter from MACM confirming registration within two weeks, please resubmit. Name: Physician/Clinic Address: Phone: Fax: I wish to register for Program Number: Place: Date: A fax or reminder will be sent to you approximately two weeks before each program. Medical Assurance Company of Mississippi / Attention: Risk Management Department 404 West Parkway Place / Ridgeland, Mississippi FAX: (601)

5 Correcting Errors in EMR Documentation: How Do You Rate? Nurses are taught early on in their education how to correct paper records, from correcting one entry to inclusion of addenda. But what about correcting electronic medical records? Let s see how your office fares. 1. Our system has the ability to track corrections or changes once the original entry has been entered or authenticated. 2. The process established by a vendor for error correction and the ability to work with the company in this area was one of the criterion when we chose our EMR system. 3. In our clinic, when correcting or changing an entry, the original entry remains viewable. 4. Whenever someone in our clinic corrects or changes an entry, he or she enters the current date and time, identifies themselves in the record, and notes the reason for the change. 5. If a hard copy of the EMR is printed and retained, we always make sure that corrections are made on the hard copy as well as in the EMR. Score: One point for each yes answer. 6. Any corrected or changed laboratory report is immediately brought to the attention of the physician, with review date/time stamped, and the original (incorrect) report is annotated as having been changed and retained. 7. Our system has the ability to block viewing of an actual error in documentation, but there is always a flag present to notify the viewer that an error has been corrected. 8. There is a system of cross-referencing original entries and corrected entries, so that viewers will always be aware that an entry has been corrected and have the ability to view both versions. 9. Our clinic has a written policy/procedure on the acceptable way to make corrections in our electronic medical records. 10. As part of our Quality Improvement efforts, we systematically evaluate whether our clinic procedures for correcting entries are followed Points: Ou t s ta n d i n g! 6-8 Points: Good, but there are some holes that need plugging! 4-5 Points: Serious gaps in your EMR risk management system! Less than 5 Points: Ti m e t o r e g r o u p a n d w o r k c l o s e ly w i t h y o u r v e n d o r t o s o lv e t h e s e issues! (ref: Correcting Errors in Electronic Medical Records authored by Georgette Samaritan, RN, Sr. Risk Mgt Consultant, MAG Mutual, Medical Liability Monitor, Vol 34, No 12, Dec 2009)

6 6 News of Note: Warning & Public Health Emergencies: Staying Informed Electronically Inundated by paper? Finding medication recall information and warnings at the bottom of your Inbox? Hearing about important Public Health Emergencies from CNN? Your answer to more efficient notification may lie with the Health Care Notification Network (HCNN). The HCNN recently merged with the Physicians Desk Reference (PDR) to provide prescribers, via electronic means, the above information and more. For more information on this available service, visit to assess whether this would be of benefit to your practice. MGMA: Online Patient Safety Resource Center Now Available The Medical Group Management Association (MGMA) has a long established reputation for being a resource for the clinics in Mississippi. Continuing in that tradition, MGMA has created an online patient safety resource center. Although a portion of the content can only be accessed by MGMA members (think about joining!), there are many items available to any healthcare professional. Go to patientsafety to access useful tools and information. MGMA provides information on patient safety, including practice safety assessments and pathways for patient safety. medical assurance company of mississippi 404 West Parkway Place Ridgeland, Mississippi macm.net PRST STD U.S. POSTAGE PAID Jackson, MS Permit No. 775 Information contained in this publication is provided by Medical Assurance Company of Mississippi for the sole purpose of risk management. It is obtained from sources considered to be accurate; however, accuracy and completeness cannot be guaranteed. It is not intended and should not be construed to be or to establish the standard of care applicable to physicians practicing in Mississippi. This information should not be regarded as legal advice. We encourage physicians to seek the advice of their own legal counsel. The Risk Manager is a publication of Medical Assurance Company of Mississippi. Editor: JoAnn Bienvenu