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#54953
06/27/2013 1:53 PM
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We have a staffer who took to pasting PMP data into an addendum and saving it to the patient's chart. Great idea, except that she regularly forgets to open the proper chart before pasting the next PMP report. Is there any way to delete the bad data? If there is, I can't find it. Thanks.
Bob
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It is not possible to delete any saved record in Amazing Charts. Only Imported Items may be deleted. You will need to follow the incorrect Addendum with another Addendum (change the date to be the same day) stating that the Addendum was saved on the wrong patient.
John
Internal Medicine
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You can probably delete via SQL Server Management Studio.
JamesNT
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You can probably delete via SQL Server Management Studio.
JamesNT Do you need the database passcode to do this? Amazing Charts has always been unwilling to provide this to users.
John
Internal Medicine
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This is one of those issues that won't go away until AC decides to address it. Even IF you can get the db passcode, there is no reason one should have to hire an IT person to used advanced software to correct data entry errors.
AC... if you are listening... how about coming up with a good way to deal with errors in patient charts????
There may be some disagreement about the best way to address this, but there is near unanimity on the need to do so.
Jon
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ryanjo,
No. The password is not required, but would be more convenient.
JBS,
Unfortunately, I don't see that idea happening. Adding more features for meaningful use and other requests gets more users = more revenue. Adding something to help someone with their data entry mistakes because they can't hire well-trained staff: not so much. At least that's the attitude I see a lot of software vendors taking these days.
JamesNT
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I think the primary reason is medico-legal. Lawyers would love to hear that you are easily able to change your EHR notes without leaving an audit trail. Your notes will then be useless if sued as you could have changed the notes to reflect what you want them to say rather than what they said before the suit.
As in paper charts you should not erase the incorrect information but line it out and correct it leaving both versions visible.
Greg
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[not a doc... just someone helping a doc w/AC] So... with paper charts, what's to prevent a misfiled note from being removed from the chart and placed in the correct chart. Or, what's to prevent a note from being removed and replaced, insted of lined out... or even removed?. I would guess this would venture into the ethics (and legal) area. But if removing a misfiled note in a paper chart and placed in the correct paper chart was OK, why shouldn't this be "allowed" with electronic records? My thought... electronic "anything" is now taken as "absolute"... FWIW
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Unfortunately we do lots of weird things now and expectations are high - when we had paper charts and the office burned down was there an expectation that we had duplicate copies of all our paper charts in another building? No but now we think we should have 8 backups in 6 locations including one locked in Norad (sorry I digress). I agree when we file something that is completely in wrong chart we should be able to hit wrong pt and move to other chart but the audit process I think would be horrendous and correct me if I am wrong I don't think any EMR makes it less onerous to do.
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Les - with paper charts any of your listed occurrences could, and statistically have happened over a large enough population. AC creates an audit trail as users take actions on data, so having a system (say with admin permissions) to move an entry to the correct patient is a straightforward task as that would be logged into both the audit trail and the admin mod log. I've built that into every major system that I've implemented over the last 20+ years. When it comes to controlled access systems, checksums and hashes are used to prevent/detect tampering. Karl Denninger explicates it nicely about medical records thus: Now it's true that I can go into the database and manually change something, overriding those controls and audit trails (anyone with "root" access on an operating environment can, in an extreme case, do that), but it's a royal pain in the butt to do, it's hard to do without screwing something up and if you do screw something up in the process it will be obvious to anyone who looks at it later that it was tampered with.
When it comes to medical records you'd think that they'd go even further. That is, it's not hard to cryptographically checksum every single entry and store the hash of that using information that is hard to "back end" into a clandestine modification later -- and which can't happen by accident. Then apply a second checksum to the aggregate. Now you have not only a nice audit trail but if someone tries to back-door modify the data absent stealing the original physician's (or other valid recording person's) private key it would be effectively impossible to tamper with the record and even if they did steal the private key the fact that the timeline was tampered with would be instantly obvious.
Why hasn't all this been done?
Incidentally if we did do that we could go even further, placing the patient in final control of all of these records without too much additional trouble. That, of course, would***** off the hospitals and insurance companies along with everyone else who wants to try to claim that your medical history isn't actually your property, but is theirs. Source http://market-ticker.org/akcs-www?post=222280The short answer is that it could and should be done, but hasn't.
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Adding something to help someone with their data entry mistakes because they can't hire well-trained staff: not so much.JamesNT Sure, this would help with staff errors, but it is often about our own (provider) mistakes. I think the primary reason is medico-legal. Lawyers would love to hear that you are easily able to change your EHR notes without leaving an audit trail. Your notes will then be useless if sued as you could have changed the notes to reflect what you want them to say rather than what they said before the suit.
As in paper charts you should not erase the incorrect information but line it out and correct it leaving both versions visible.
Greg EXACTLY on the second part of your post... the EMR doesn't make a good correction system harder and less "secure"; just the opposite. Every action is logged so you could easily allow for lining things out, but a permanent record of the error is maintained in the record. Indy provides the best, succinct analysis of the situation: The short answer is that it could and should be done, but hasn't. It is a shame AC chooses not to deal with these (years old) requests.
Jon
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