electronic medical records · • nextgen cons: 1. drop down menus and templates make it easy to...

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

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

Informed Consent Issues With EMR

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


• 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

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

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

electronic medical records · • nextgen cons: 1. drop down menus and templates make it easy to...

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