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Many negatives may come with using EMRs
The potential benefits of electronic medical records (EMRs) are easier to spot than the possible drawbacks, according to some risk managers. Consider both the pros and cons of EMRs before adopting the technology, they say.
William D. Yoquinto, JD, an attorney with the law firm of Carter Conboy in Albany, NY, cites these possible problems with EMRs:
When the electronic medical record is printed, it usually shows the date and time and identity of the person who printed it. Depending upon the timing and the person doing the printing, this can highlight the date that the case became a concern and suggest to astute plaintiff's counsel some avenues of inquiry. For example, if the record is printed before there is an authorization by the patient and the person requesting is a hospital director of risk management and quality assurance, the attorney may be encouraged to pursue the claim and then certain avenues of discovery.
Another problem relates to the imprinting of time in the record. Typically, the electronic medical record will automatically note the time the record is made. This can be confusing if the person making the record fails to record the time of treatment within the body of the typewritten entry. This automatic generation of time can be advantageous in comparison with the (fairly typical) untimed progress note or order within a hospital chart. To the extent that the professional delays in making documentation, however, it can give the impression of a delay in treatment, which requires more explanation.
There could be a problem regarding how the EMR relates to coded templates for examinations of patients and autotext. If the recorder is not fluent in the use of the software, this can result in troubling inconsistencies of documentation. "In one case I had involving emergency department care of a septic patient, the emergency doctor's electronic record reflected both labored breathing and no shortness of breath. The system in that case had only been in use for about a month. So, they were on the uphill side of the learning curve."
An additional issue arose in the same case involving sepsis. The computer-generated times for telemetry were clearly incorrect. In fact, the times recorded actually appeared to begin hours before the patient arrived in the ED. This not only made the record appear questionable, but it did not assist in demonstrating that the patient was well monitored when in the department. "We never had a satisfactory explanation as to how that occurred, but it brought to mind the old adage, "garbage in, garbage out."
Gwen Hughes, RHIA, CHP, director of e-HIM Consulting Services at Care Communications Inc. in Chicago, points out that EMRs are only as good as their design, implementation and the systems and behaviors of the individuals supporting and using them. She worries that the potential availability of data and metadata to attorneys under new rules of evidence may in fact increase malpractice suits or the size of awards. The fact that research has not yet demonstrated an increase in suits or awards may be a matter of timing, she says.
"Suits and awards may increase as EMRs become more prevalent and attorneys figure out how best to leverage the information contained therein," she says. "I'm not suggesting organizations should not move forward with implementation of EMRs. I'm emphasizing rather the importance of re-engineering processes to fully leverage the technology and the importance of strong systems around documentation, health information management, compliance, security, and risk to maximize the return on investment."
For more information on potential drawbacks of EMRs, contact:
Gwen Hughes, RHIA, CHP, director of e-HIM Consulting Services, Care Communications Inc., Chicago. Telephone: (312) 422-0106.
William D. Yoquinto, JD, Carter, Conboy, Case, Blackmore, Maloney & Laird PC, Albany, NY. Telephone: (518) 465-3484. E-mail: email@example.com.