Important Considerations When Adjusting to EHR Updates

I have been a “power” user of the EHR at my community hospital since I joined the medical staff, and I have been an early adopter of all the changes and enhancements to our facility’s EHR.

They have been coming fast and furious this year, much to the chagrin of the bulk of the medical staff. We have seen a number of changes recently to our EHR in response to concerns about fraud, and more specifically, the practice of “cloning” records.

I have written about the risks and benefits of cloning of existing electronic records in the past, and suffice it to say that it is a two-edged sword. On the one hand, cloning can be a great time saver when there is little or no change in the condition of a hospitalized patient. On the other hand, it can lead to propagation of “ratty” data, and previous errors, if the author of the note is not diligent in reviewing and correcting the note after it is cloned.

There is an even bigger concern; and that is the specter of fraud, which cloning makes much easier.

I have also appreciated the value of the EHR both as a timesaver, as well as a way to better document my work, therefore improving the billing process.

Our EHR is a wonderful data gathering tool when it comes to the social history, diagnostics, procedures, labs, input and output values, ventilator settings, etc. It also enables us to easily and rapidly gather data into a progress note or history and physical examination, with a few clicks and checkboxes. Try doing that by hand sometime with a hard copy record.

With the recent addition of enterprise level medical dictation to our system, one of the major barriers to EHR adoption in our facility  has been significantly lowered.

Unfortunately, this very promise of the computer and technological age has given some providers the tools that they need to scam the system.

Our facility has made two changes in recent months in response to industry wide concerns regarding cloning. The first is to eliminate the checkbox in the add a record section of the EHR that allowed us to select a previous record (e.g., existing progress note, history and physical examination, etc.), and “copy it to a new record.”

I used this feature most often when copying progress notes and histories and physicals, and I will greatly miss this feature. In burns and plastic and reconstructive surgery, we have a lot of patients that we admit for day surgery repetitively for outpatient surgery, and the ability to “bring forward” the previous history and physical from six weeks ago, and update it for the current procedure was a great time saver.

The second is correction of “in error” records. In the old system, one had to “in error” the record and create a new one, a very laborious and time consuming process. Now we will have the ability to correct existing records.

When we need to correct a record, we are presented with two choices: “Correct”, which allows us to change information that we already put into the record to make it more accurate, or “modify”, which allows us to add new, additional information. The record is then flagged in red at the top that it has been “corrected” or “modified.”

Somewhere among all of this technology and concerns about the impact of it, we will find a balance that meets everyone’s needs. Until then, we will have to live with and effectively respond to the unintended consequences of the evolution of the EHR.

This blog was provided in partnership with the American Academy of Physician Assistants.