Practice Fusion Blog

Who “owns” a patient’s medical record?

Traditionally, a patient’s medical information has been segmented into charts that exist in various places – the offices of the doctors involved, hospitals, etc. Each doctor’s chart is a medico-legal record of the advice given to the patient by the doctor, resides in the doctor’s office, and is “owned” by the doctor. Medical records retention policy applies here, such that a doctor is obligated to maintain the record for some specified minimum period of time, which varies depending on the circumstances. Coming from this framework, a physician may wish to destroy “old” records, believing that such old records might increase a physician’s liability were they to be available. Many malpractice carriers, and even some medical societies, however, have seen chart documentation as the best way to protect physicians from malpractice allegations and encourage long-term retention – even indefinite retention – as desirable.

 

The move towards shifting medical record-keeping to electronic formats has changed this paradigm. Especially as hosted EHRs emerge that can allow chart sharing, such that there is a single “one-patient one-chart” record for a given patient across all loci of care, the question of who “owns” the patient’s chart becomes more complicated. Overlay onto this the consumer-driven desire for a portable Personal Health Record (PHR) – even though currently, most PHRs are disconnected, empty shells that rely on patients to maintain their own data, the future is for PHRs to be dynamically filled and connected to their physician’s EHR – there is the position that it is the patient who “owns” his/her health data.

 

With the push toward greater interoperability among EHRs, hospitals, laboratories, PHRs and other sources of patient data, we can now see the emergence of a patient-centered unified health record that is shared by all practitioners involved in a given patient’s care, and used for medical decision-making and advice-giving. So, questions relevant to the old, paper-based and physician-centered paradigm of “can I destroy old records that are past the statute of limitations for legal action?” becomes more complicated in the new interconnected era. With a unified patient-centered chart, can a physician delete or at least block from access his/her old chart notes? What impact on malpractice liability exists with unified patient-centered charts? These are the questions that are emerging, and for which we need clear consensus. The emerging technology puts us on a different footing, and raises issues not previously seen.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Medical Records Retention and EHRs

How long should medical records be retained, whether on paper or electronically? Does keeping records indefinitely increase one’s exposure to liability? These questions have occasionally arisen, and deserve commentary.

 

The most important reason for keeping medical records is for coordination of care with other health professionals. It is also an important way of documenting care when defending against malpractice allegations – sometimes, malpractice allegations can be quite incomplete in their presentation of facts, and a well-documented medical record is the best defense a physician has against such claims.

 

There are minimum time frames which obligate a physician to retain records – seven years for adults in most instances is common, though other circumstances may require longer retention. The main driver here is the statute of limitations for filing malpractice actions. Even if there is record-keeping older than the statute of limitations, it is not open to subpoena if it is past the statue of limitations. The California Medical Association has concluded that, while a retention period of at least 10 years may be sufficient, it recommends that records be retained indefinitely, or, in the alternative, for 25 years. A good summary by a malpractice insurance carrier can be found here.

 

Like with most EHRs, Practice Fusion is able to keep electronic health record data indefinitely, in electronic form. This does eliminate the economic burden of maintaining old records for long periods of time. Having good longitudinal medical records data not only serves continuity of care, it provides long-term defense for physicians against malpractice allegations.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

How long should medical records be retained, whether on paper or electronically? Does keeping records indefinitely increase one’s exposure to liability? These questions have occasionally arisen, and deserve commentary.

 

The most important reason for keeping medical records is for coordination of care with other health professionals. It is also an important way of documenting care when defending against malpractice allegations – sometimes, malpractice allegations can be quite incomplete in their presentation of facts, and a well-documented medical record is the best defense a physician has against such claims.

 

There are minimum time frames which obligate a physician to retain records – seven years for adults in most instances is common, though other circumstances may require longer retention. The main driver here is the statute of limitations for filing malpractice actions. Even if there is record-keeping older than the statute of limitations, it is not open to subpoena if it is past the statue of limitations. The California Medical Association has concluded that, while a retention period of at least 10 years may be sufficient, it recommends that records be retained indefinitely, or, in the alternative, for 25 years. A good summary by a malpractice insurance carrier can be found here.

 

Like with most EHRs, Practice Fusion is able to keep electronic health record data indefinitely, in electronic form. This does eliminate the economic burden of maintaining old records for long periods of time. Having good longitudinal medical records data not only serves continuity of care, it provides long-term defense for physicians against malpractice allegations.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Google Health and other PHRs are low value

Jay Parkinson recently wrote an article here about how Google Health will flop.  I concur with Jay but think there's a bigger reason why more PHRs are low value and wanted to share this here.

PHRs have been of notoriously low value, and Google’s is no exception. As a patient, your data is in your doctor’s office, and the vast majority of physicians are still practicing on paper. This means that Google will never be able to retrieve a patient's health record, which contains allergies, past medical history, charts, prescriptions, labs, etc making Google Health very low value. 

The only way to provide a Personal Health Record of value is to have one that is natively connected to the physician’s office, where the patient’s official record resides. This is the type of electronic health record platform that will be able to save lives and cut tremendous costs, both for the physician and the patient. 

Practice Fusion is currently extending our platform to enable PHRs and others to plug into and access patient charts (only with the physicians'/patients') permission, of course. 

I invite both practitioners and partners to check out the Practice Fusion Free EHR at www.practicefusion.com to see why we are the fastest growing EHR community in the US.

 -Ryan Howard
CEO, Practice Fusion

A common EHR decision question: “Do you have templates for my specialty?”

A common question that many practitioners have when looking for a suitable EHR for their practice is this: will it have features needed for my specialty? Is it a general-purpose EHR system, or is it specialty-specific? And what kinds of features in a specialty-specific product are missing in a general-purpose one? Is that important?

More specifically, where physicians often start to differentiate EHR options available to them is by looking at templates. Are there templates suitable for my specialty? This question, seemingly straightforward on the surface, is actually more complex than would appear. That is because “templates” mean different things in different EHR systems.

 

The simple answer

The simple answer for Practice Fusion is “yes.” Practice Fusion offers many universally-needed features, like medications, prescribing, summary information, document management and messaging. But at the same time, Practice Fusion includes a Template Library, which contains a collection of over 130 different templates, grouped into specialties, so that every specialty has tools apropos the common (as well as unique) workflows for that specialty. The Template Library grows continuously, as users in different specialties offer their own templates for distribution in the community. By grouping templates into Template Categories, and associating the categories with different specialties, Practice Fusion is able to auto-populate your own template collection, based on your declared specialty, on first-use of the system – you can always search for any template from the complete library if you so need.

 

More about templates

EHRs of all types have grappled with the balance of structured data on the one hand (which is searchable and lends itself better to interoperability) and descriptive, narrative text on the other hand (which is more readable by practitioners, and familiar to all). “Templates” are ways of trying to capture chart data for note creation – and their use and character depends on how the underlying EHR is created. Some EHRs are extremely “template driven,” meaning that a template is a form on a screen with lots of items to click, which create data in tables associated with each such template. This approach favors “structured data” as the most important thing – queries across each data element is possible, but the system often loses in “usability” and physicians complain that it takes them longer to chart using the EHR than it did before (thus impacting their productivity). Also, since the very-granular data created is so template-centric (it has even been referred to as “structured data over-kill”), it is difficult to import or export data between different installations of the EHR that use different collections of templates. Further, custom-creation of templates by users on-the-fly is nearly impossible.

 

Practice Fusion takes a different approach when it talks about “templates.” In Practice Fusion, usability and quickness of note-creation are centrally important, so that using the system will not result in the productivity slow-down experienced by users of other EHRs. “Templates,” as used by Practice Fusion, are collections of sentences and phrases commonly used in creating chart notes about certain types of visits. These kinds of templates are tools that allow for simple sentence-picking, and can be mixed-and-matched at will. The sentences chosen can be modified as desired, and supplemented with free text as well. These templates are stored in a Template Library, and can be individually modified as needed. New templates can be created and stored by the user without difficulty.

 

The result of the Practice Fusion approach to “templates” is a quick and easy way to build narrative chart notes, particularly the “S” section of a SOAP note – HPI, PMH, ROS, FH, SH, etc. The note is easily readable by other practitioners, and has the ability to capture truly descriptive narrative often highly important in describing a clinical situation, which might not be well captured in the stiffer click-driven templates of other EHRs. The challenge with this approach, of course, is the use of standard terminology and structured data for querying and interoperability. That is why the template usage approach implemented by Practice Fusion is mainly for parts of the note that should be narrative (e.g. HPI – history of present illness); other elements, like diagnoses, medications, prescriptions, immunizations, allergies, vital signs, etc., are structured and discrete, and lend themselves quite nicely to usable queries, reports, and interoperability.

 

Conclusions

“Templates” mean different things to different EHR systems. Physicians who ask the question “do you have templates for my specialty?” are asking a more complex question than meets the eye. There are EHRs in the marketplace – established, large, expensive ones included – which are very stiff and template-centric, and can negatively impact usability. Practice Fusion has tried to learn from these lessons, and offer a different approach to templates, which is more flexible, user-modifiable, and quicker, yet at the same time can create chart notes with sufficiently structured data elements where robust report-creation and interoperability are achieved.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.