Electronic Medical Records (EMR) in Discovery

Transcription

1 Electronic Medical Records (EMR) in Discovery Tips and Tools for Both Sides of the Fence Monday, January, :00 PM Eastern Sponsored by the ABA Health Law Section Nursing and Allied Healthcare Professionals Task Force

2 Daphne Press, RN LNC Vice Chair Programming Nursing and Allied Healthcare Professionals Task Force

3 Objectives: Note the expectations and realities of EMRs. Learn what factors contribute to EMR Litigation. Discover some helpful resources for making sense of EMRs.

4 Benefit Touted #1 Improved Coordination of and Access to Healthcare Information Purpose Interoperability Paperless

5 Purpose of EMR in improving coordination of care and access to patient information Paperless documents are more efficient and cost effective Ready access across multiple platforms and locations Care of the patient not a product for the courts

6 The Pitfalls of EMRs Inter- and Intra-system Malfunctions Unexpected Costs of Implementation and Use Producible/ Readable Formats Clinical/ Billing/ Research Not made for Bates Numbers and Chronologies

7 Benefit Touted #2: Improved Accuracy Regulations Coding Billing Documentation Progress Notes Communication Orders Medical Decision Making Bar-codes

8 Accuracy Issues Templates vs Customization Billing Algorithms User Expectations Software Limitations

9 Accuracy Issues Physical Malfunctions Technical Malfunctions Electronic Malfunctions Equipment

10 Accuracy Issues Work Arounds Policies vs Practice Accept CPOE Process Malfunctions

11 Why Work Arounds and Reluctance to Leave Paper? Preferences CPOE Rigidity Workflow

12 A 2009 study in the International Journal of Medical Informatics identified 11 categories where medical practices used paper instead of electronic health record systems.

13 Justifications for Paper Use Ease of Use Efficiency Memory Longitudinal Data Security Sensorimotor Preferences Task Specificity TRUST Awareness Task Complexity Data Organization

14 Other Challenges to Accuracy: Log Off Errors Timing Errors Relying on Others To Err is Human Copy Paste Selection Errors

15 Perpetuating False Information Possible Fraud Copy and Paste Increases Cost of Production in Discovery

16 Accuracy Pitfalls Related to Software Upgrades and Usability Proprietary vs Database Mgr. Changes in Vendor Conversion Issues Frequent Changes During Go- Live Events

17 Software Pitfalls Continued Narratives Templates Flowsheets Prepopulated Fields Typing Skills Needed Reduces Billing Fraud Underused vs Redundant Misuse of Default Fields Accommodations (Transcriptionist or VR Software) Regulatory Compliance Locating or Implementing Predetermined Task Lists

18 Touted Benefit #3 Improved Quality of Care Provider Disconnect Practice Economics E and M Coding Forces Immediate Chart Completion Less Pay Increased Documentation Requirements Missed Communications Lack of Reconciliation More Patients Shorter Appointments

19 Touted Benefit #4 Improved Patient Safety Alarms can: Reduce medication errors Warn Providers of unsafe order entry Alert HCPs to lab values Notify Nurses of changes in VS Remind staff of pending tasks

20 Pitfalls of EMRs for Improved Patient Safety Alarm Fatigue causes warnings to go unnoticed. Providers resent intrusions on clinical decision-making. Lab values are under-reported, erroneously reported or reported to the wrong person. Increased workloads cause task reminders to go unheeded.

21 Touted Benefit #5 Providers are held accountable. Discipline Specific Access HIPAA Native Format Reveals All

22 Touted Benefit #5 Providers are held accountable. Even if no information was documented, a record of who accessed a chart is made when that person logs on. (Nurses fired for reading suspected Ebola victim s chart when they weren t the caregivers.) Chart Lock Down events- Discharge, Death, etc. Standardized processes for addendum charting.

23 According to the KLAS Black Book Report, only 30 percent of nurses say their IT departments respond quickly to fix aspects of the EHR that they point out as vulnerabilities in documentation. Document, document, document every time, date and person you notify of an issue with your EMR.

24 QUESTIONS