Re: [Op-torch-general] changes to interface

[Sam B. <dr...@ch...>]

Dear Mike:

These are all valid points.  The usual scenario is that the defendent 
finds some typo, mistake or just polishes the chart to hide some fact. 
The very ease of making "invisible" changes is very seductive.

The way the plaintiff attorney finds out about the changes are that 
records are frequently transferred to other physicians and insurance 
carriers. The attorney tries to find multiple copies of the same medical 
record. When these records come in to the plaintiff's attorneys, they 
carefully search for discrepancies between the copies. The "invisible" 
changes by the physician are very easy to identify and prove.

Once this type of change comes out in court, the physician has been 
caught "in a lie" and his/her credibility goes to zero. The plaintiff's 
attorneys then have a field day.

Sam Bowen, MD

Michael A Rowley wrote:

> Hey Guys,
>
> The problem as I see it is, that the DB doesn't afford "write 
> protection" on a per entry basis, I don't know of any db that does 
> allow this.  The only way to do it is through the interface... Even if 
> you could readonly the db entry, it wouldn't be necessarily a good 
> thing.  As I said in a previous entry, the best place to put 
> modifications to a chart is as an addendum to the chart... So when the 
> entry is finalized, through the web interface you could only add an 
> addendum, but not edit the original content, and the addendum would be 
> flagged with the user, and the date and time the addendum is entered.
>
> Now, as I said in the beginning of this, if you have access to the DB 
> (which you do in every EMR if you know what you are doing) you can 
> edit the DB manually and change whatever you want...  Even a read only 
> disk could be copied, changed and rewritten.  Even in a paper chart, 
> it is fairly easy to change the record, and difficult to prove.
>
> I will check with a friend of mine on the EMR legal aspects.  He does 
> a lot of legal defense for med mal.
>
> Michael.
>
>
> On Thursday, April 22, 2004, at 08:28 AM, docv wrote:
>
>> Sal
>>
>> How about this as an 'electronic alternative'?
>>
>> Once the mistake is found, a new entry is made in John Berry Smith's 
>> record (current date) detailing the error event. The wording from the 
>> erroneous entry is then copied (including the date of original entry) 
>> and pasted to Mr. John B. Smith's EMR in an entry under the current 
>> date with an addendum attached that contains a detailing of the error 
>> once again.
>>
>> Perhaps, under a system such as this, the error in John Berry Smith's 
>> record could then be 'electronically/automatically' marked as an 
>> error, somehow. :-)
>>
>> This is just an idea that came to mind as I read your example. I am 
>> not sure how much trouble this would be to implement such an error 
>> correction procedure from within the TORCH interface. Perhaps Michael 
>> or Tim could comment on that?
>>
> Michael Rowley MD
> FP
>
>
>
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