Road to electronic records filled with many potholes
By David Main
Partner, Shaw Pittman
Washington, DC
(Laws and procedures regarding medical records are evolving quickly, thanks to technology and new regulations. This question-and-answer format by consultant David Main addresses some of those trends.)
Question: What is the biggest challenge facing health care providers with regard to medical records?
Answer: The biggest problem that health care professionals face is the transition from paper to electronic records. Medical records have been in paper form for so long, it will be a huge challenge for providers, hospitals, and insurance companies to convert records into electronic forms in a way that will maintain integrity.
Technology is the future of the industry. Patients want it for convenience and accuracy. For example, I went to a doctor the other day for a checkup. His practice has two locations, and I had been to his other office previously. When I arrived for my appointment, he didn’t have my file, even though I had told the office to transfer the records. Electronic records could have solved this problem. Soon patients may want to make appointments on-line like they buy airline tickets.
Moving to an electronic model will have its advantages and disadvantages for providers. On the one hand, electronic medical records are port-able, they are easier to code for billing and business purposes and more convenient. Generally, the main challenges when dealing with electronic records are privacy, integration (i.e. having systems that communicate effectively with each other), human errors, and duplication. It is important for providers to keep up with the technology, stay informed, and also remember that electronic medical records are not infallible.
Question: How can medical record mix-ups occur?
Answer: Many hospitals have five or six computer systems that don’t talk to each other. Under such circumstances, when accessing data you may not end up with a complete file. There could be pieces of information on different computers. Integration of computer systems is key.
There can be instances of duplicate medical records. For example, a patient’s last name might change, or there could be two people with the same last name who end up with each other’s medical files — a very dangerous situation.
There is also the human error element; data may be recorded incorrectly, and there can be a false sense of security engendered by electronic records. A provider may look at a computer screen and assume that a record is complete or correct, when in fact, it is not.
Question: How can medical record errors be avoided?
Answer: Health care professionals need to stay abreast of the technological developments in the industry. There are usually many local resources, associations, and trade publications that provide information about new technology. For example, here in Washington, DC, we recently formed the HealthTech Network, made up of providers and health care professionals from the Greater Washington area who meet once a month to discuss these issues.
There are many Web sites and companies offering low-cost technology and services such as on-line claims processing for providers; Healtheon/ WebMD is an example. For hospitals with complicated records systems, the problem of medical records mix-ups may be tougher and more expensive to resolve. Physicians as well as other pro-viders have to realize they are in a very rapidly changing environment. The new platform is a technological one. For example, I recently heard that medical students at Duke receive a laptop with all their books, lectures, and work for the next four years upon arrival. They plug in their laptops at the library to study. It is a different world!
Question: What legislation has been put in place to prevent medical record mix-ups?
Answer: There has been very little. There have been hearings on Capital Hill about medical records, and there are some proposals on the books that would require medical record errors to be reported and resolved by a specific agency. The only solid legislation, the Health Insurance Portability and Accountability Act (HIPAA), has been enacted to protect the privacy of electronic medical records.
Question: Will HIPAA help prevent medical record mix-ups, and how will this legislation affect health professionals?
Answer: HIPAA will probably help prevent medical record errors because it will impose strict technology requirements to maintain security. Providers using electronic records will be required to have the sophisticated technology necessary to ensure the privacy of records.
HIPAA will be the standard, and the balance is in favor of the patient, in favor of privacy. Electronic records will have to be secure. Of course, HIPAA does not apply to paper records, so a provider will have two choices: Either keep paper records, or comply fully with all the HIPAA standards. Under the regulations, it is an absolute requirement that electronic records remain secure and private.
Question: What impact will new technology have on individual providers?
Answer: We are in the process of upgrading an entire industry. Many providers won’t be able to afford the new technology that will be required to maintain electronic medical records.
There is a shortage of capital and reimbursement at the federal level for the hospital industry, and many individual providers may react the way my doctor did — simply hope to retire before having to convert to an electronic practice. But technology is the future of the business. Providers, in cooperation with hospitals and insurance companies, should strive to learn more and embrace technology.
[David Main is based in Washington, DC, and is a partner with the health care practice of Shaw Pittman. You can contact him at (202) 663-8443. E-mail: david. [email protected]. Web site: http://www.shaw pittman.com.]
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