LNCtips.com: My Experts' #1 Gripe
I work with experts
from many different fields -
pediatrics, cardiology, neurology, nephrology, geriatrics,
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
medical records (easy identification of treater names, for example),
there are several things that my experts hate about the
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
a normal newborn whose length of stay is a day or two. But
about a baby who's in the neonatal ICU for several
can we do as legal nurse
consultants to make our and our experts' reviews easier? The Summer
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
link the pages to your chronology.
3) OCR the medical
records. OCR stands for Optical Character
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
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
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
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
request electronic records in the most efficient way possible.