Electronic signatures save time and money
Program the latest step in automation for agency
Home Care of Southern Ohio in Portsmouth, a Medicare-certified agency that serves six counties in Ohio and Kentucky, computerized its documentation in 1993. As staff got more comfortable with the automation, the administrator, Karen Marshall, MS, RN, decided that the next big step should be using electronic signatures.
Last March, the agency started the program, and although Marshall has no way to precisely measure its impact, she says she's sure it is a huge time and money saver. "We aren't printing notes and putting them in mail boxes. Clinicians save an hour a week they used to spend in the office signing paperwork. There is less paper shuffled, which means less paper lost."
Marshall decided to implement the program when Delta Health Systems in Altoona, PA, released the latest version of the software package the agency uses. "We believed that the integrity of documents, specifically clinical notes and verbal and telephone orders, was sufficiently secure to implement authentication via electronic signature."
Authentication occurs through the use of unique identifiers, which are the clinician's operator number and password. To meet Conditions Of Participation and Joint Commission standards, the agency developed a policy and a second confidentiality statement for the use of a computer secure entry. (See insert for sample documents.) The Computer Access Confidentiality Agreement is signed by each clinician prior to the use of electronic signature and renewed annually when staff performance appraisals and other paperwork are signed.
Security a big issue
The policy reflects the gravity of the electronic signature program, says Marshall. It requires the clinician to notify the system administrator immediately if the confidentiality of the unique identifier is jeopardized. "We know we have to be more careful than in the past. You just can't sit down at a colleague's computer and ask for a password so you can quickly show something or to surf the Internet," she says.
If the confidentiality of the system is breached and the employee does not let the appropriate person know, then disciplinary action, up to and including termination, can occur. Computer Access Confidentiality Agreements are maintained by the system administrator and are stored in a locked cabinet, she adds. Marshall also conducts a quarterly test in which the agency's ability to reconstruct electronic records in case of a system crash is measured.
Complete buy-in
Because the ability to use electronic signatures was included in the latest software package, there were no costs associated with it, says Marshall. She didn't have to sell the idea to her 210 employees either. Staff were thrilled with the potential time savings.
"It is a huge time and money saver. Staff no longer have to return to the office to sign clinical notes. Since we are maintaining clinical notes electronically, clerical staff time is also saved. We do not print, sort, or file clinical notes. Very few documents are now printed and filed into the paper records," she says.
Before embarking on such a program, Marshall says agencies should review state licensing regulations and laws regarding the use of alternative signatures. "Clinicians also need to understand that when the form is saved, that is the final check," she says. "Within the context of electronic signature, when the clinician saves the form, they are, in essence, signing the form. Clinicians should not take this lightly."
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