Years ago in my work as expert witness I realized that the paper versions of EMRs documenting care at early adopters like HMOs and the VA seemed awkward and poor representations of the actual computer record. A few days ago a prominent hospitalist friend observed at a grand rounds on EMR that these systems have become so complex and unique that each may require training and even certification for the physicians who use them, a significant problem for docs who cover hospitals with different EMRs.
Will these facts affect future litigation? Will an expert need certification to be a credible witness in a case where records are electronic? Will it suffice to provide the expert a stack of printed records, or must access be granted to the EMR itself, perhaps even in the courtroom, to achieve a valid picture of the record? If so, how will we provide the expert an accurate picture of the record at the relevant point in time?
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A related issue might be what the expectation should be when a provider gets an EMR printout from another provider that is difficult to interpret, but makes some clinical decision based on a guess about what it means, or overlooks some important bit of data. The way things print out sometimes varies depending on browser, printer settings etc. so any one printout may vary from another even of the data seen electronically may not have changed.
ReplyDeleteRight crockbport, but for the "meaningful use" test I recently sent a dummy record to my own PCP via email. I have yet to receive an electronically transmitted record, but who's to say whether the electronic version will be better or worse than the printed version? Maybe in the best case the record I receive will be from the same EMR I use. Perhaps better yet we could access each others' EMRs directly with view-only privileges.
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