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Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

An EHR Vendor’s Efforts to Address Physician Burnout with Corinne Proctor Boudreau from MEDITECH

Posted on January 24, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Physician burnout is a major problem in healthcare. While there are a lot of things that are contributing to physician burnout, many like to point to the EHR as a major reason why so many physicians are getting burnt out. So, while the EHR can’t completely solve physician burnout, a well designed EHR can help to alleviate some of the stress a physician experiences.

With this idea in mind, we jumped at the chance to sit down with Corinne Proctor Boudreau, Senior Manager, Physician Experience at MEDITECH, to learn about what MEDITECH is hearing from their customers about physician burnout and what they’ve been doing and plan to do to alleviate this challenging problem.

Check out our full physician burnout interview with Corinne Proctor Boudreau embedded below or on YouTube.

You can find all of Healthcare Scene’s interviews on the Healthcare Scene YouTube channel. Also, at the start of the video, I mentioned our new conference, Health IT Expo happening at the end of May in New Orleans. We hope you’ll all be able to join us in New Orleans to learn about practical innovations that can benefit your organization.

Hospitals Puts Off Patient Billing For Several Months During EMR Rollout

Posted on January 6, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s something you don’t see every day. A New Hampshire hospital apparently delayed mailing out roughly 10,000 patient bills going back as far as 11 months ago while it rolled out its new EMR.

According to a report in the Foster’s Daily Democrat,  members of Frisbie Memorial Hospital’s medical staff recently went public with concerns about the hospital’s financial state. Then a flood of delayed patient bills followed, some requesting thousands of dollars, the paper reported.

Hospital officials, for their part, said the delay was planned. Hospital president John Marzinzik said Frisbie needed time to implement its new Meditech EMR and didn’t want to send out incorrect bills during the rollout.

In fact, Marzinzik told Foster’s, under the previous system, records generated during doctor visits weren’t compatible with forms for hospital billing.

Rather than relying further on this patchwork of incompatible systems, Marzinzik and his staff decided to wait until the process was “absolutely clean” for patients. The hospital decided to have a staff member validate every balance shown on a statement before sending them out, he says.

Previously, in December of last year, anonymous Frisbie medical staff members sent Foster’s a letter to share concerns about the hospital and its administrators. The criticisms included skepticism about the over-budget implementation of the $13.5 million Meditech system, which they named as one of the reasons they lack confidence in the hospital administration. The staff members said that this cost overrun, as well as other problems, have undermined the hospital’s financial position.

As is always the case in such situations, hospital leaders took the stage to deny these allegations. Frisbie Senior VP Joe Shields told the paper that the hospital is in sound financial condition, and also said that the only reason why the Meditech project went over budget by $1.5 million was that the administrators delayed the implementation by seven weeks to give the staff holiday time off.

Hmmm. I don’t know about you, but to me, some parts of this story look a little bit bogus. For example:

* I appreciate accurate hospital bills as much as anybody, but the staff was going to check them manually anyway, why did it take 10 or 11 months for them to do so?

* The holidays take place at the same time every year.  Did administrators actually forget they were coming to an event that necessitated an almost 10% cost overrun?

Of course, only a small number of people know the answers to these questions, and I’m certainly not one of them. But the whole picture is a little bit odd.

Merged Health Systems Face Major EHR Integration Issues

Posted on January 2, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Pity the IT departments of Advocate Health Care and Aurora Health Care. When the two health systems complete their merger, IT leaders face a lengthy integration process cutting across systems from three different EHR vendors or a forklift upgrade of at least one.

It’s tough enough to integrate different instances of systems from the same vendor, which, despite the common origin are often configured in significantly different ways. In this case, the task is exponentially more difficult. According to Fierce Healthcare, when the two organizations come together, they’ll have to integrate Aurora’s Epic EHR with the Cerner and Allscripts systems used by Advocate.

As part of his research, the reporter asked an Aurora spokesperson whether health systems attempt to pull together three platforms into a single EHR. Of course, as we know, that is unlikely to ever happen. While full interoperability is obviously an elusive thing, getting some decent data flow between two affiliated organizations is probably far more realistic.

Instead, depending on what happens, the new CIO might or might not decide to migrate all three EHRs onto one from a single vendor. While this could turn out to be a hellish job, it certainly is the ideal situation if you can afford to get there. However, that doesn’t mean it’s always the best option. Especially as health system mergers and acquisitions get bigger and bigger.

To me, however, the big question around all of this is how much the two organizations would spend to bring the same platforms to everyone. As we know, acquiring and rolling out Epic for even one health system is fiendishly expensive, to the point where some have been forced to report losses or have had ratings on the bond reduced.

My guess is that the leaders of the two organizations are counting often-cited merger benefits such as organizational synergies, improved efficiency and staff attrition to meet the cost of health IT investments like these. If this academic studies prove this will work, please feel free to slap me with a dead fish, but as for now I doubt it will happen.

No, to me this offers an object lesson in how mergers in the health IT-centered world can be more costly, take longer to achieve, and possibly have a negative impact on patient care if things aren’t done right (which often seems to be the case).

Given the other pressures health systems face, I doubt these new expenses will hold them back from striking merger deals. Generally speaking, most health systems face little choice but to partner and merge as they can. But there’s no point minimizing how much complexity and expense EHRs bring to such agreements today.

Hospital Takes Step Forward Using Patient-Reported Outcome Data

Posted on December 6, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I don’t usually summarize stories from other publications — I don’t want to bore you! — and I like to offer you a surprise or two. This time, though, I thought you might want to hear about an interesting piece appearing in Modern Healthcare. This item offers some insight into how understanding patient-generated determinants of health could improve outcomes.

The story tells the tale of the Hospital for Special Surgery, an orthopedics provider in New York City which provides elective procedures to treat joint pain and discomfort. According to the MH editor, HSS has begun collecting data on patient-reported outcomes after procedures to see not only how much pain may remain, but also how their quality of life is post-procedure.

This project began by doing a check in with the patient before the procedure, during which nurses went over important information and answered any questions the patient might have. (As readers may know, this is a fairly standard approach to pre-surgical patient communication, so this was something of a warm-up.)

However, things got more interesting a few months later. For its next step, the hospital also began surveying the patients on their state of mind and health prior to the procedure, asking 10 questions drawn from the Patient-Reported Outcomes Measurement Information System, or Promis.

The questions captured not only direct medical concerns such as pain intensity and sleep patterns, but also looked at the patient’s social support system, information few hospitals capture in a formal way at present.

All of the information gathered is being collected and entered into the patient’s electronic health record. After the procedure, the hospital has worked to see that the patients fill out the Promis survey, which it makes available using Epic’s MyChart portal.

Getting to this point wasn’t easy, as IT leaders struggled to integrate the results of the Promis survey into patient EHRs. However, once the work was done, the care team was able to view information across patients, which certainly has the potential to help them improve processes and outcomes over time.

Now, the biggest challenge for HSS is collecting data after the patients leave the hospital. Since kicking off the project in April, HSS has collected 24,000 patient responses to nursing questions, but only 15% of the responses came from patients who submitted them after their procedure. The hospital has seen some success in capturing post-surgical results when doctors push patients to fill out the survey after their care, but overall, the post-surgical response rate has remained low to date.

Regardless, once the hospital improves its methods for collecting post-surgical patient responses, it seems likely that the data will prove useful and important. I hope to see other hospitals take this approach.

When It Comes To Meaningful Use, Some Vendors May Have An Edge

Posted on December 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new article appearing in the Journal of the American Medical Informatics Association has concluded that while EHRs certified under the meaningful use program should perform more or less equally, they don’t.

After conducting an analysis, researchers found that there were significant associations between specific vendors and level of hospital performance for all six meaningful use criteria they were using as a yardstick. Epic came out on top by this measure, demonstrating significantly higher performance on five of the six criteria.

However, it’s also worth noting that EHR vendor choice by hospitals accounted for anywhere between 7% and 34% of performance variation across the six meaningful use criteria. In other words, researchers found that at least in some cases, EHR performance was influenced as much by the fit between platform and hospital as the platform itself.

To conduct the study, researchers used recent national data on certified EHR vendors hospitals and implemented, along with hospital performance on six meaningful use criteria. They sought to find out:

  • Whether certain vendors were found more frequently among the highest performing hospitals, as measured by performance on Stage 2 meaningful use criteria;
  • Whether the relationship between vendor and hospital performance was consistent across the meaningful use criteria, or whether vendors specialized in certain areas; and
  • What proportion of variation in performance across hospitals could be explained by the vendor characteristics

To measure the performance of various vendors, the researchers chose six core stage two meaningful use criteria, including 60% of medication orders entered using CPOE;  providing 50% of patients with the ability to view/download/transmit their health information; for 50% of patients received from another setting or care provider, medication reconciliation is performed; for 50% of patient transitions to another setting or care provider, a summary of care record is provided; and for 10% of patient transitions to another setting or care provider, a summary of care record is electronically transmitted.

After completing their analysis, researchers found that three hospitals were in the top performance quartile for all meaningful use criteria, and all used Epic. Of the 17 hospitals in the top performance quartile for five criteria, 15 used Epic, one used MEDITECH and one another smaller vendor. Among the 68 hospitals in the top quartile for four criteria, 64.7% used Epic, 11.8% used Cerner and 8.8% used MEDITECH.

When it came to hospitals that were not in the top quartile for any of the criteria, there was no overwhelming connection between vendor and results. For the 355 hospitals in this category, 28.7% used MEDITECH, 25.1% used McKesson, 20.3% used Cerner, 14.4% used MEDHOST and 6.8% used Epic.

All of this being said, the researchers noted that news the hospital characteristics nor the vendor choice explained were then a small amount of the performance variation they saw. This won’t surprise anybody who’s seen firsthand how much other issues, notably human factors, can change the outcome of processes like these.

It’s also worth noting that there might be other causes for these differences. For example, if you can afford the notably expensive Epic systems, then your hospital and health system could likely afford to invest in meaningful use compliance as well. This added investment could explain hospitals meaningful use performance as much as EHR choice.

Amazon May Soon Announce Major Cloud Deal With Cerner

Posted on November 27, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As I’ve previously noted, Amazon is making increasingly aggressive moves into the healthcare space of late. While it hasn’t been terribly public with its plans—and why should it, honestly?— there been some talk of its going into the healthcare technology space. There’s also much talk about angles from which Amazon could attack healthcare sectors, including its well-publicized interest in the pharmacy business.

Though interesting, all of this has been vaguely defined it best. However, a new deal may be in the works which could have a very concrete effect. It could change not only the future of Amazon’s healthcare industry efforts but also, potentially, have an impact on the entire health IT world.

Think I’m exaggerating? Check this out. According to a story on the CNBC site, Amazon is about to announce a “huge” deal with Cerner under which the two will work together on building a major presence in enterprise health IT for Amazon Web Services. Put that way, this sounds a bit hyperbolic, but let me lay this out a bit further.

As things stand, the online retailer’s Amazon Web Services is already generating almost $20 billion a year, boasting clients across major industries such as technology, energy and financial services. Its only stumbling point to date is that it’s had trouble cracking the healthcare market.

Apparently, at the re:Invent conference in Las Vegas next week, AWS’s CEO will announce that Amazon is teaming up with Cerner to convince senior healthcare leaders to use AWS for key initiatives like population health management.

Sources who spoke to CNBC that the partnership will initially focus on Cerner’s HealtheIntent population health product, presumably as a door into convincing hospitals shift more of the cloud-based business to AWS.

Now why, you ask, is this deal bigger than the average bear?  is it one of those vaporware partnerships that fly a flag and promise a lot but don’t really go anywhere?

Yes, I admit that’s always possible, but in this case, I don’t think it’s going to turn out that way. The fit simply seems to work too well for this to be one of those much-ballyhooed deals that fade away quietly. (In fact, I could visualize a Cerner/Amazon merger in the future, as crazy as that might sound. It’s certainly less risky than the Whole Foods deal.)

For one thing, both Amazon and Cerner have significant benefits they can realize. For example, as the story notes, Amazon hasn’t gotten far in the healthcare market, and given its talent for doing the impossible, it must be really stuck at this point. Cerner, meanwhile, will never pull together the kind of cloud options AWS can offer, and I doubt Epic could either, which gives Cerner a boost in the always next-and-neck competition with its top rival.

If this agreement goes through, the ripples could be felt throughout the healthcare industry, if for no other reason than the impact it will have on the enterprise EHR market. This one should be fun to watch. I’m pulling out the popcorn.

Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?

Epic Mounts Clumsy Public Defense On False Claims Lawsuit

Posted on November 6, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A former employee of a health system using Epic filed a False Claims Act whistleblower suit claiming that the vendor’s platform overbills for anesthesia services by default. The suit claims that Epic’s billing software double-bills both Medicare and Medicaid for anesthesia, as well as commercial payers.

At this point, let me be clear that I’m not accusing anyone of anything, but in theory, this could be a very big deal. One could certainly imagine a scenario in which multiple Epic customers colluded to permit this level of overbilling, which could generate staggering levels of overpayment. If so, one could imagine hospitals and health systems paying out judgments that add up to billions of dollars. To date, though, nobody’s made such a suggestion. In fact, Epic has said essentially the opposite and pointed to the need to understand how medical billing works, but we’ll get to that.

In the suit, which was filed in 2015 but unsealed this month, Geraldine Petrowski contended that Epic’s software was billing for both the base units of anesthesia for procedures and the time the procedure took.

Petrowski, a former employee with the compliance team at Raleigh, N.C.-based WakeMed Health & Hospitals, alleges that setting the billing to these defaults has resulted in “hundreds of millions of dollars in fraudulent bills” submitted to Medicare, Medicaid and other payers. (WakeMed is an Epic customer.)

According to an article appearing in Modern Healthcare, Petrowski developed these concerns when she worked with Epic as the provider’s liaison for its software implementation between 2012 and 2014. In the complaint, she says that she raised these concerns with Epic, but got a dismissive response. Eventually, after Petrowski kept up the pressure for a while, Epic fixed the billing issue — but only for WakeMed.

Apparently, the U.S. Department of Justice reviewed Petrowski’s case and decided not to intervene, a fact which Epic has not-surprisingly mentioned every chance it gets. Perhaps more tellingly, the vendor has suggested that Petrowski filed the suit largely because she’s clueless. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh told the magazine.

Now, I don’t want to go off on a rant here, but if the best public defense Epic can mount in this case is to offer some mixture of “everybody’s doing it” and “you’re a big dummy,” you’ve got to wonder what it’s got to hide.

Not only that, trying to brush off the suit as the product of ignorance or inexperience makes no sense given what’s involved. While False Claims whistleblowers can collect a very large payoff, getting there can take many years of grueling work, and their odds of prevailing aren’t great even if they make it through the torturous litigation process.

No, I’m more inclined to think that Epic has tipped its hand already. I’d argue that fixing only the WakeMed billing system shows what the legal folks call mens rea – a guilty mind — or at least a willingness to ignore potential wrongdoing. Not only that, if the system was operating as expected, why would Epic have gotten involved in the first place? Its consulting services don’t come cheap, and I’m guessing that Petrowski didn’t have the authority to pay for them.

It doesn’t look good, people…it just doesn’t look good.

Sure, the hospitals and health systems using Epic’s billing solution are ultimately responsible for the results. Maybe Epic is completely blameless in the matter this case. Regardless, if Epic’s hands are clean, it could do a better job of acting like it.

Avoiding EMR-Related Lawsuits In The ED

Posted on October 25, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s hardly a secret that while EMRs may offer clinical benefits, they aren’t quite the patient safety or risk management tool one might hope they would be. Hospitals have much greater luck mining EMRs for clinical intelligence retroactively than they have using them to avoiding liability, in part because many aren’t designed to offer such protection.

But according to medical malpractice insurer CNA, there are steps hospitals can take to avoid EMR-related liability in the emergency department, in many cases if they simply avoid some key pitfalls which have caused problems for facilities in the past.

Avoiding copy and paste problems

As we all know, copying and pasting repetitive parts of a patient record from one note to another — such as the patient’s history — can save physicians lot of time. And if that’s all that gets copied, it’s seldom an issue.

However, when physicians rely too heavily on copy and paste functions, it can have a negative effect on patient care, in part by disseminating error-laden or outdated information, CNA has found. Overuse of copy-and-paste functions can also flood records with excess information and make it hard for subsequent providers to find what they need.

To avoid patient care errors associated with the use of copy and paste functions, CNA’s recommendations include the following:

  • Establish policies laying out how copy and paste functions should be used
  • Require clinicians to get ongoing education on proper use of these functions and patient safety risks associated with copy and paste misuse
  • Use a voice-activated dictation system for EMR data entry
  • Have the EMR highlight all copied information and/or prevent copying of high-sensitivity information such as the history of present illness
  • Audit EMRs to understand how providers use copy and paste, and responding when they seem to be abusing this function

Managing requests for EHR-based information

If your ED is facing a professional liability claim, you are likely to face requests for paper production of EMR archives. Part of your goal will be to limit how much EHR-based information is legally discoverable.

An important step in doing so is defining the legal medical record (LMR), which includes information on the provision of clinical care which would reasonably be expected upon request during discovery.

However, producing paper copies of EMR-based information differs from producing records originally created on paper, and hospital emergency departments might face additional liability issues if they haven’t prepared for this adequately. To do so, steps they can take include:

  • Developing policies and procedures for responding to requests for copies of the EMR and audit trails
  • Offering ongoing education for medical staff and employees on best practices for EMR documentation
  • Disclosing the EMR electronically in read-only mode rather than as a paper document

Eventually, of course, hospitals will want to do more than patch together defenses against problems that can occur when using a typical EMR design. Ultimately hospitals will want to make EMRs easy to use and supportive of clinical goals without being too intrusive. I know, most of us feel like we’ll grow old and gray waiting for this to happen, but we mustn’t let it fall off the radar.

In the meantime, the strategies CNA outlines could help your ED avoid medical malpractice litigation and protect patients from needless harm. It may be a transitional strategy but it’s better than nothing.