Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Electronic Medical Records:
Benefits & Dangers Of The Paperless System
Presented By: Kirsten K. Ullman – Partner, Tampa
Co-Presenter: Bryan Reid – Partner, San Bernardino
Electronic Medical Records (EMRs): The Goal
• Improve Quality of Care
• Improve Efficiency of Care
• Share Medical Information with Other HCPs
Involved in The Patient’s Care
• Improve Legibility of Documentation
Electronic Medical Records (EMRs): Legibility
Electronic Medical Records (EMRs):
Benefits For Quality of Care
• Knowledge of and Coordination of Medications
Among Providers
• EMR Systems Are Backed Up In Case of
Disaster
• Access In Event of Accident/Emergency
• Able To Track Labs and Radiographic Studies
Without Duplication of Testing
Safeguards From Breach
• Passwords and PIN Numbers
• Encryption-Only the users of the System That
Can Decrypt Can Access
• Audit Trails- Tracking of Users Who Access
The Health Information
• If a Breach, Notification Is Required
• Increased Protections Enacted In 2013
Documentation Integrity
• Accurate and Complete Health Record
• Reflect Accurate Patient Condition
• Remove Default Template Data
– Automatic Population of Old Information
– Automatic Population of Old Findings In Review of
Systems
– Cut And Paste
– Templates
• Different Patients
• Different Doctors
• Identical Descriptions Including Incision Size
Legal Issues Of EMRs
Increased Malpractice Risks Associated w/ EMRs
• Change Over From Paper To EHRs • Repetitive Data • Time Consuming
– From a Jotted Note To – 10 Mouse Clicks
• Prone To Shortcuts – Cut And Paste – Authorship Validation – Templates
• Re-population of Old Information • Confusion Re Timing of Entries • Drop Down Screens Can Prompt Error • Amendments/Changes In Entries • Verification of Author
Reduce Complexity & Duplication
Reduce Complexity & Duplication
Increase Safeguards
• Require Verification of Cut And Paste Entries
• Caution With Drop Down Menus
• Caution Re: Texts That Do Not Get Into EMR
Legal Issues Of EMRs
Legal Issues With EMRs
Cut And Paste Shortcut
Legal Issues With EMRs
Legal Issues With EMRs
Informed Consent Issues With EMR
Informed Consent Issues With EMR
Informed Consent Issues With EMR
Informed Consent Issues With EMR
Informed Consent Issues With EMR
Confusion Re Timing of Care
Confusion Re Timing of Care
Liability Exposure Due To EMR
• 9:33 Patient Arrived From Home
• 9:37/9:38 Call from L&D To Midwife’s Cell
• Midwife Enroute To Hospital
• 9:45 Emergent C Section Called By Midwife per
EMR notes
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
• 9:45 Note Re Calling of STAT C Section
Inconsistent with Other EMR Charting
• 10 am Consent Signed
• 10:02 Call To Dr. P From Midwife
• 10:07 Moved to OR
• Other Op Records
• 10:23 Delivered
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Liability Exposure Due To EMR
Physician EMR Experiences
• About the EMRs, I have Nextgen for my office and Mckesson/ Navicare Watchchild
for L&D.
• Nextgen pros: 1. allows me to see the patient’s prior encounters with all the other providers in our clinic. 2. facilitates e-prescribing. 3. improves medical record documentation and legibility. 4. facilitates medication reconciliation. 5. facilitates delivery of educational materials to patients as required by meaningful use 2.
• Nextgen cons: 1. drop down menus and templates make it easy to overlook significant clinical info. 2. drug-drug interaction or drug allergies alerts can be very frequent and time consuming causing providers to override them. 3. Nurses or medical assistants can enter a wrong drug or dose. The doctor should always verify that info with the patient prior to submitting the prescription to the pharmacy.4. Providers often copy and paste info from prior notes into new notes without editing, as appropriate. 5. An item can be selected above or below the one desired, so “qd” can become “qid”.
• Navicare Watchchild pros: I can remotely log in and see at all times the fetal heart rate tracing from home or my office. This allows me to anticipate problems and not rely solely on the nurse’s knowledge or expertise.
• Navicare Watchchild cons: A limited number of available diagnoses that I can select from the drop-down list.
• On June 1st, 2015 our entire hospital will transition to a new EMR, called CERNER. I will keep you posted!
Virtual Medicine And EMR
Virtual Medicine And EMR
Text Messages And EMR
Recommendation
• In Developing EMR Systems, Consult Jury
Consultants Or Your Trial Counsel
Recommendation
Example:
In Shoulder Dystocia Cases- Common Issues:
1) No Estimated Fetal Weight Before Admin of Pitocin
Drop Down Requiring Submission of Weight Estimate
1) Description of Delivery
Templates Re Gentle Downward Guidance; Assisted Natural Downward Guidance Versus Downward Traction Force