Recently, I was preparing my physician-client for his deposition in a medical malpractice lawsuit. At the end of the meeting, he asked me: “How can I do better in the future?” My client was referring to his entries into the electronic medical record (EMR). With the transition to EMRs, this is one question that all medical providers should be asking. My initial blogs will discuss the problems with EMR and how they present in litigation.
When I was a less-seasoned medical malpractice attorney, one of my biggest challenges was to decipher a physician’s handwriting. Now, one of the biggest challenges is to understand all of the information on the printed page. When I say “information,” I’m not focusing on the medicine anymore. In fact, in many cases, the medicine is secondary to the seemingly superfluous information that appears on the printed medical record.
While I am certainly not an expert in the creation, design or even use of EMRs, I often wonder whether software designers ever considered – for maybe even a nanosecond – the possibility that the information would one day need to be printed on an 8.5” x 11” sheet of paper.
In preparing the physician-client for his deposition, we attempted to recreate a timeline of events to determine when he was first contacted to consult on the patient. The problem with EMR is that there are many “time stamps” in each record. It is unclear whether stamp marks the time the text was inputted or the time the entry was opened or closed out. This makes it very difficult to create a timeline of events. Questions arise during deposition as to what each time stamp documents, so a physician can become tripped up even with the best preparation.
Another issue that arises with time stamps is the time of the signature – especially when this is hours after an office appointment or days after discharge. The late date/time stamp destroys the credibility of that entire record at deposition. In another case, I have an entry signed out two days after the patient was seen and after the physician was aware of a catastrophic event. Her well-written record will be called into question because there is an implication that the entire record was written after the catastrophic event and that it is inaccurate as a result.
To my client, how can you do better?: (1) Write your notes and close them out as soon as you provide care and (2) learn what your EMR looks like when its printed, and accommodate that format.