Srneph, thanks for sticking with your thread and elaborating your concerns. Bert, thanks for explaining what you meant; I think we can all agree that it is sad to have to worry so much about the medico-legal aspects of chart signing. It is also clear that there are some legitimate quality of care issues as well.
Srnephdoc, in my post above, I explained why I think the automated messages are the real concern here. Again, a message left in the wrong place for a vacationing doc is a recipe for disaster; that is true with a paper or electronic message. Did that make sense to you and fit with your experience? If so, then perhaps your interface(s) can be configured to be brought into one common message box. All the labs, etc. would come to one box which is opened by a staff person who sends them to the appropriate doctor, and if someone is away, they would know to route it to the covering doctor. That doc reviews it, files it, AND sends it to the box of the vacationing doc who sees it upon his return.
That's
exactly the situation about which I expressed concern, and also the kind of solution most offices use with paper. It results in as many as three people instead of one having to handle incoming "stuff," but dramatically decreases the likelihood something will get stuffed into a paper or electronic chart without the proper eyes seeing it. In our nephrology practice, the most common potential problems are things that result from additional decline in GFR in patients with advanced CKD (hyperkalemia, dramatic decrease in hematocrit, big rise in BUN, worse metabolic acidosis,
etc.
All our incoming paper lab reports are screened by a staffer who works from parameters we've given her. Nothing goes directly into a chart or onto a vacationing doc's inbasket without being seen by a covering doc, but those with "alert" level values are put on the covering doc's desk flagged to be seen today, and of course anything with a "panic" level value is called to the doc immediately. Results with no "alert" or "panic" values are still screened by the covering doc before being put on the vacationing doc's desk. Of course, if the patient is in hospital and the covering doc is managing the patient daily, sometimes things that happen to an individual doc's patient can go to the chart from the covering doc without passing underneath the vacationing doc's eyes, but they've been "handled" by the covering doc who's temporarily doing the patient management anyway.
The EHR should have a similar capability, and because of the swarms of lawyers just ready to pounce, it should be able to track who did what and when.
