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LNCtips.com: My Experts' #1 Gripe

I work with experts from many different fields - pediatrics, cardiology, neurology, nephrology, geriatrics, maternal-fetal medicine, orthopedics, rehab, surgery, internal medicine, family medicine, obstetrics, gynecology, corrections, etc. While the experts may work in different areas of healthcare, they all have the same gripe.  It's turning into my #1 gripe too.

The gripe is related to reviewing electronic medical records.  While there are things to like about electronic medical records (easy identification of treater names, for example), there are several things that my experts hate about the

1)  Electronic medical records are VOLUMINOUS! Instead of reviewing one flowsheet, the experts and I have to review pages entitled, "Lines Drains and Tubes," "Cardiovascular Assessment," "Genitourinary Assessment" and so on.  Each system or tube has its own page (or more often, many pages.)   I've reviewed electronic medical records that are thousands of pages, which was tedious at times.  Because of the excessive volume of the records, it takes longer to sift through information to find key facts.

2)   Hospitals sort the records in a peculiar order.  For example, I recently reviewed some electronic medical records that seemed to have no order until I realized that they were sorted first by the ordering practitioner, and then by the date the practitioner authenticated the order.  Dr. Albertson's orders were first, even though he didn't see the plaintiff until she had been in the hospital for a week. The next orders were Dr. Boyden's, followed by practitioners with the last names of Conrad, Doyle, and so on.  Again, it can take additional time to locate key case details.

  3) They're repetitive.  With some types of electronic health records, documentation is repeated over and over again.  For example, a newborn nursery nurse's admission assessment might appear on all subsequent nursing assessments.  That's not too burdensome for a normal newborn whose length of stay is a day or two.  But what about a baby who's in the neonatal ICU for several months?     

            

What can we do as legal nurse consultants to make our and our experts' reviews easier? The Summer 2015 Journal of Legal Nurse Consulting has some excellent suggestions.  I particularly liked Cheryl Gatti's roundtable discussion because I learned some new approaches and validated some of my own practices for requesting and reviewing medical records.  I'd like to add three additional suggestions that apply to both behind-the-scenes and expert LNCs.

1)  Create a medical chronology (even if it's a handwritten one on a piece of paper) as you review the medical records.  As nurses, we're using to flipping between sections of the chart (progress notes, MARs, etc.) to quickly find what we need.  This approach may not work since the records  are in a different order than paper records,  A medical chronology will help you write down facts as you find them.

2)  As you're making the chronology, note the page number of your electronic file or printed page in your chronology so that you'll be able to find the page easily.  Luckily, most electronic medical records are numbered.  (Unfortunately, the numbered pages makes it difficult to organize them.)  Behind-the-scenes LNCs could also use CaseMap to link the pages to your chronology.

3)  OCR the medical records.  OCR stands for Optical Character Recognition.  When electronic medical records are in PDF format (as most are), they LOOK like they contain text.  However, you can't search or copy tand paste he text in PDF documents unless they've been OCRd.   Using OCR allows you to search for a particular word important to the case such as "Foley," "CT," or "fall."  Performing keyword searches doesn't replace a thorough review, but in some cases, it can help you and you experts find information more quickly. Adobe Acrobat Standard, Adobe Acrobat Pro, Nuance, and NitroPDF Pro software is capable of OCRing PDF documents; Acrobat Reader is not.  OCRing documents is a laborious process for voluminous records.  Start the process at a time when you won't be using your software for another reason for at least a few hours.


There's no doubt that electronic medical records are here to stay.  As LNCs we're all learning how to review and request electronic records in the most efficient way possible.

...Katy Jones                         

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