Shelter from the Coming Malpractice Storm: EMR Evidence Management DISCLAIMER: The views and opinions expressed in this presentation are those of the

Transcription

1 Shelter from the Coming Malpractice Storm: EMR Evidence Management DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Ira Victor, G2700 GCFA GPCI GSEC CGEIT CRISC Digital Forensic Analyst Salary and consulting fees: DataClone Labs Mark Inda, BA Computer Science Principal Salary and consulting fees: InContext Data 2012 HIMSS

3 Learning Objectives Identify problems hospitals face when defending malpractice with electronically stored data Evaluate tools that exist to easily prove data legitimacy Discuss possible solutions to collect every activity of every practitioner/employee throughout the hospitals, in context, to later be able to prove the hospital s and practitioner's intent, competency and quality

4 Agenda The Challenge Study: Tools for Risk, Quality and Compliance Solutions to Mitigate Risk Examples

5 PLEASE SHOOT ME. You are required to turn over data that becomes the equivalent of a loaded gun which is eventually pointed straight back at you Does it really have to be this way?

6 Plaintiff Attorneys Twisting the Data placing an overemphasis on the EMR s date and time stamp. using the date and time stamps to try to show the actual length of the visit at issue and the amount of time spent between physician and patient. Electronic Medical Records: Litigation Experience and Risk Management Tips Elizabeth A. Leedom, JD, Bennett Bigelow & Leedom, PS, Physicians Insurance

7 This PACs Log Cannot Defend You Dr. Smith reviewed the images On June 6 th 2011, 4:33PM Only shows time of folder access No one knows how well he conducted this examination

8 Discovery Is A Herculean Task data must be pulled from multiple sources to create a complete record. Extremely time and resource-consuming efforts to produce information All too often plaintiffs are requesting access to the live EHR itself... This could potentially require painstaking collaboration with the vendor itself and IT professionals. For Lack of a Proper Print" Function The Difficulties in Responding to Subpoenas to Produce the EHR, by Krystyna H. Nowik, Esq.

9 Twisting the Data in Court certain definitions may mean one thing for purposes of one hospital's EHR but something else for another EHR. This discrepancy would have to be explained in court by a knowledgeable member of the hospital's HIM or IT department. in court, the EHR technology, functions and capabilities may look nothing like when the physician actually had access to the information. imagine the number of people required to testify as to the system s capabilities, lags in time procedures were actually performed and actually entered into the EHR, current and prior functionalities For Lack of a Proper Print" Function The Difficulties in Responding to Subpoenas to Produce the EHR, by Krystyna H. Nowik, Esq.

10 EMR Difficult Witness in Court The challenges stem from systems, which were built for care not court a trial can easily shift its focus from an examination of care to a fault-finding mission with the recordkeeping system the provider s inability to put forward the information in a comprehensible format may raise suspicions that it is missing, withholding, or obscuring information. EHRs Prove a Difficult Witness in Court, Chris Dimick, Sep 24, 2010, AHIMA Journal

11 This EMR Log Cannot Defend You What happened during an interaction with Test, Greg on Monday June 6 th, 2011?

12 Mark Inda studied over 100 Hospitals Initial intended to market an off-the-shelf tool. Completely changed the way we looked at risk management, quality management and compliance.

13 Why The Challenge Exists Many risk managers overwhelmed Many risk managers love and fear data We have heard: The lawyers take care of this There s nothing else we can do It won t happen here

14 Tools and Processes Commonly Used Log files, more log files and still more log files Interviewing practitioners Log consolidation tools Proprietary EMR vendor tools

15 Large NJ Hospital Spinal cord injury brought into the ER Patient later discharged as a paraplegic Patient claims hospital did not provide care Hospital lacks ability to show what happened Result Plaintiff's Attorney Implies Lack of Data = Poor care Hospital settles, cannot defend

16 Small Hospital in Texas Invisible, Broken Doctor s Orders Processes Handwritten and faxed orders to ER Scanned into a PDF ed as an attachment to proper department Manually entered into EMR Result Risk of errors and litigation

17 Large For-Profit ASC in Nevada Nurses using SMS ( Texting ) to communicate with physicians Patient information in clear text Result Hidden from risk managers and EMR, risk of litigation, texting speak creates doubt of accuracy

18 The Results Little time to pro-actively identify seminal events Problems discovered too late Hospitals need the ability to definitively explain events Hospitals settle medical malpractice claims regardless of fault

19 Meeting the Challenge Simple, low-cost, off-the-self tools Strong authentication Collect data from the PC Bring data together in one place Visualize events, exactly as they occurred

20 EMR Multi-Vendor Applications Containing Patient Data Imaging System Scanning System LAB System Web Applications No Changes to Any Existing Systems Agent Installed on Devices Throughout the Hospital See Events Exactly as They Occurred Active Event Discovery, Resolution and Prevention Collected Data

21 EMR Audit Log What happened during an interaction with Test, Greg on Monday June 6 th, 2011

22 Event Log In Context Date Time User Computer Program Window Caption and Keystokes 6/6/ :08:24 butoraca PCTR-8 PowerChart HNAM Logon - \\Remote 6/6/ :08:39 butoraca PCTR-8 PowerChart [HNAM Logon - \\Remote] <6:08:39 PM> wcsocial 6/6/ :08:46 butoraca PCTR-8 PowerChart PowerChart Organizer for Test, WC Social Worker - \\Remote 6/6/ :09:28 butoraca PCTR-8 PowerChart [PowerChart Organizer for Test, WC Social Worker - \\Remote] <6:09:28 PM> test, greg 6/6/ :09:36 butoraca PCTR-8 PowerChart <N/A> 6/6/ :09:36 Test, WC Social Worker PowerChart /6/ :10:26 butoraca PCTR-8 PowerChart TEST, GREG Opened by Test, WC Social Worker - \\Remote 6/6/ :13:30 butoraca PCTR-8 PowerChart <N/A> 6/6/ :13:40 butoraca PCTR-8 PowerChart [Add Document: TEST, GREG \\Remote] <6:13:40 PM> VisitDr. Khazanasked me to tsee the patient while here, as the last time patient was in there was conflict with siblings how to best care for him at home. 6/6/ :14:33 butoraca PCTR-8 PowerChart TEST, GREG Opened by Test, WC Social Worker - \\Remote 6/6/ :14:36 butoraca PCTR-8 PowerChart Add Document: TEST, GREG \\Remote 6/6/ :14:57 butoraca PCTR-8 PowerChart TEST, GREG Opened by Test, WC Social Worker - \\Remote 6/6/ :15:10 butoraca PCTR-8 PowerChart TEST, GREG Opened by Test, WC Social Worker - \\Remote 6/6/ :16:21 butoraca PCTR-10 ssmypics.scr Screen Saver 6/6/ :19:57 butoraca PCTR-10 PowerChart TEST, GREG Opened by Test, WC RN - \\Remote 6/6/ :20:07 butoraca PCTR-10 PowerChart [TEST, GREG - Add Order - \\Remote] <6:20:07 PM> hemoglo 6/6/ :20:17 butoraca PCTR-10 PowerChart [Ordering Physician - \\Remote] <6:20:17 PM> test, whphy 6/6/ :20:24 butoraca PCTR-10 PowerChart [Provider Selection - \\Remote] <6:20:24 PM> <Delete> 6/6/ :26:12 butoraca PCTR-8 PowerChart PowerChart Organizer for Test, WC Social Worker - \\Remote

23 Social Worker Using the EMR Click here to play Or link to

24 PACs Audit Log Dr. Smith reviewed the images On June 6 th 2011, 4:33PM Only shows time of folder access No one knows how well he conducted this examination

25 Event Log In Context Event Data Event Time User ID Minutes of Active Time Minutes of Total Time Computer ID Program Window Caption and Keystokes URL 6/6/ :32:42 DunnP 0:00:11 0:00:11 PC2E-4 IExplore Welcome to emed.net 6/6/ :32:42 DunnP 0:00:01 0:49:35 PC2E-4 IExplore emed.net 6/6/ :32:44 DunnP PC2E-4 IExplore Welcome to emed.net - Microsoft Internet Explorer provided by The County Hospital 6/6/ :32:53 DunnP 0:00:00 0:00:00 PC2E-4 IExplore 6/6/ :32:53 DunnP 0:00:38 0:49:23 PC2E-4 IExplore Exam List name=smithd&criteria=limit%3d30%26srch%3d %27PNAM%3Druehl%26PNAM%3D%2Cjames%26 SORT%3D%22%2BPNAM%22%27 6/6/ :32:54 DunnP 0:00:05 0:00:05 PC2E-4 IExplore Installing emed.net Software 6/6/ :33:05 DunnP PC2E-4 IExplore Exam List - Microsoft Internet Explorer provided by The County Hospital Jonesm 6/6/ :33:36 DunnP 0:09:01 0:48:40 PC2E-4 IExplore Studies for JONES, BOB, Sex:M, DOB:1/08/1950, MRN: /6/ :22:41 DunnP 0:00:13 0:01:18 PC2E-4 IExplore The County Hospital Intranet ivileges=67&lastname=jones&firstname=bob& mrn= %5epu5t&dob=1%2f08%2f1950&se x=m&exam=%2d%5ee5lb1&study=30447%5estpt 0ek&modality=CT&referrer=/oncall.html

26 Dr. Smith Examining the Patient Press Play Click here to play Or link to

27 Re-Cap The Challenge The Study Simple Solutions

28 Q&A Ira Victor Digital Forensic Analyst x2000 Co-Host, CyberJungle Radio CyberJungleRadio.com Mark Inda InContext Data