Hi David, At the first level your statement re admissibility/inadmissibility of paper versus paperless records is correct, but correct with caveats. The Rules of Evidence can vary with the Jurisdictions and the perceived need to enter the 'available record' may permit 'other' records to be admitted (classbook exceptions).
This asides, courts may well apply a higher standard upon Healthcare Practitioners, Facilities, Payers and Patients that translates into 'You should have created and maintained this record and therefore you must comply with fewer permitted exceptions'. Another tack would be the reasoning that: 'You produce lots of legally admissible records and therefore must meet an additional burden to get the Court to admit this one'. An inadmissible 'record' regardless of form and content can complicate matters. As for multiple copies, modifications, errors, omissions and unauthenticated records, these can result in 'hair-pulling' events. For example, the attorney that drew up a trust formation (standard form) document for my parents omitted a single sentence. This came from a standard for straight off an Internet site. How the sentence went missing is a mystery. The fun part came when the interpretations of multiple attorneys were compared. To avoid having the whole document thrown out by the Court, and the controlling Trust document, an out-of-Court settlement was achieved. Recognize that no one, even the initial Attorney, detected the missing sentence until the end-of-life for the Trust approached. Applying this to Healthcare as an analogy results in the conclusion that 'Doing it right the first time in a legally sufficient manner may avoid bad stuff later'!! Other: -If something crucial shows up on your monitor screen, do a Screen dump to a file and create a time/date stamped archive. It is a record and a mechanism exists to produce a permanent copy easily reproduced on paper. -admissible records that indicate a complete, continuous, correct, accurate, precise process are preferable over those that are incomplete, disconnected, incorrect, inaccurate and/or imprecise. They make easy targets. Regards! -Thomas Clark Bigpond wrote: >"That is not feasible" > >And that's the problem that will keep the technical people in money for >years to come. Not only must it be feasible it will be demanded by judges >and courts if the EHR is to ever be truly adopted. Even now we have rules >that all e-mails where a decision is made must be printed out! >The paperless world has never been to court. >It is feasible of course but complex. Flags are set when pages are viewed, >there are intricate audit trails (terabytes). The fact that no one is doing >it yet is that the litigation costs haven't risen high enough to balance the >need to do it. Once a few specialists are sued for activities that can not >be supported by the record and they known they were innocent then we will >see some very interesting changes, either a reappearance of paper records >(personal) or a new paradigm of image capture. IMHO of course. > >David > >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of Karsten Hilbert >Sent: Saturday, 5 March 2005 8:22 AM >To: openehr-technical at openehr.org >Subject: Re: Demographics service > > > >>The EHR is rather a unique document and a layered approach is necessary as >>old data must never be altered - may not necessarily be accessible but >> >> >must > > >>never be altered. Errors can be corrected but the error must remain >> >> >totally > > >>accessible in the manner it was presented to the clinician when it was >>relied upon - eg clinical results, medications. >> >> >That is not feasible as it would amount to taking physical >pictures of the screen as it looked when displayed. And even >this would only prove what the user *might have seen had she >tried* - certainly not what she *saw*. > >Karsten > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
