Do you have an EMR forensics expert?

In this exciting era of healthcare moving from paper medical records to electronic medical records (EMRs), there is a burgeoning new skill set and expertise that will be required more and more.

It is a skill set that one may not be thinking about even today, until you discover you REALLY need that expert. The last 10 years have had a great deal of focus first on hospitals and secondly on physician practices moving to electronic records with the passing of the American Recovery and Reinvestment Act (ARRA) of 2009. Healthcare receives litigation claims regularly and defending the hospitals and physicians now has another layer of complexity as defense now depends on the ability to explain the medical record output from and EMR to a paper chart, which may or may not be clearly understood, especially by a jury of lay persons.

The ARRA act made provisions for the financial incentives that stimulated and accelerated the move to electronic records. The potential to pay for the capital investment of the healthcare technology proved to be a huge incentive to deploy the EMRs that were finally becoming comprehensive, usable and widely adopted. Although we had our resident curmudgeons who did not want to move to the technology, many embraced it and charged ahead to meet the deadlines to receive the reimbursement from ARRA.

Throughout the entire life cycle of selecting, contracting and deploying EMR technology, the primary focus has always been on data input, workflow and business intelligence. Getting visibility on the care being provided to patients, access to the medical record from anywhere and with multiple care givers at one time kept the focus on the here and now when a patient was admitted. The business intelligence was less compelling at the time of the deployment, although it was in the back of the minds of the leadership. Everyone was excited that discreet data entry would provide so many more opportunities for data collection, aggregation and analysis. Dashboards were a glimmer of hope and often times designed later in the process. The key vision was patient care with discrete data input.

Healthcare has received a great deal of litigation due to the emotional nature of the adverse outcomes that may or may not be related to negligence or incompetence. For anyone who has had the experience of having loved ones in a healthcare setting, you can appreciate the intensely personal nature of the encounter. Emotions become even more heightened when patients end up with an injury, a disability or, worse yet, death. Patient and families will often consider and potentially file a medical malpractice claim as a result of adverse outcomes.

Now your physician practice or hospital has been served with litigation related to a poor patient outcome. The plaintiff is going after everyone, the hospital, the physicians, the nurses and anyone else who may have had the privilege of caring for that patient during difficult encounters with less than optimal outcomes. Yes, there are times when patient outcomes are due to negligence, poor workflows or malpractice. The majority of the time we have families that have been emotionally impacted, financially ruined and lives disrupted because the productivity, love and support of the family member is no longer the same due to the health status and adverse outcomes from their human condition. Humans have complex biology and there are both health issues that can be treated with good outcomes and those that cannot.

The EMR now becomes the center of attention as hospitals and physicians attempt to defend themselves in a court of law. The data output and the mechanisms that create a paper version of the EMR need to be fully understood to defend. The EMR is relational database the stores data in tables. There are tables that store the discrete data options and those that store the historical data related to an EMR patient record. There are executable files that will pull from those database files to create the paper EMR. Understanding the date and time stamps on those paper files are critical to help explain discrepancies, inconsistencies and confusing information. Data input screens do not look the same as the data output that comes out in the paper records that are often sent to the plaintiff's attorneys and the defense counsel. The attorneys also need to understand the information to better defend the claims against either the healthcare system or the staff. Data input screens have time and date stamps that capture the data changes and inputs by each and every individual entering data into the EMR. Those cannot be altered in any way. They also can create confusion as to what occurred in and in which sequence of the data entry in the many different ways that the information can be captured by the EMR. There are also foreign data feeds into EMRs that also create either discrete or BLOB (Binary Large Object) data. Understanding those interfaced pieces of the EMR also will need to be explained and defended.

When a medical malpractice claim is filed, often times the plaintiff will attempt to lay blame on everyone that may have come in contact with their loved one and also to blame the technology that supported the care of the patient. Emotions are raw and the only way to realize compensation for the poor outcomes becomes a claim of negligence or malpractice. That is exactly what the plaintiff's attorneys will focus on, the emotion and not the logic. The defense counsel must overcome that emotion be presenting the jury with a competent EMR forensics expert that can present the facts in a simple and factual way that takes the emotional impact of the perceived injustices by the claimant.

• With 56% of claims receiving compensation at an average $458,348 according to the New England Journal of Medicine1, it is prudent for hospitals, physician and attorneys to understand the need for an EMR Forensics expert that truly understands the difference between data input and data output from an EMR. The tide is changing and there is a new specialty that ARRA has inadvertently created.

I would love to hear your thoughts on EMR forensics. I can be contacted at kate.crous@smartexectech.com

Kathryn Crous
CEO of Smart ExecTech Inc.

1. http://www.nejm.org/doi/full/10.1056/NEJMsa054479#t=article

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