Life in the Trenches

If certain reformers have their way and electronic medical records are used to control treatment plans, physician actions, and payments, how will mistakes in the record be handled?

WhiteCoat's Call Room reports a case in which the hospital laboratory made an error in measuring a patient's potassium level. The value was so high, the physician ordered another test. The second test showed the potassium level was normal, but the lab report did not show that the test had been done to correct an improbably high value in the original test. The physician asked the lab to send the report from the first test along with the report for the second test in order to justify his order of a second test. The lab said it couldn't do this.

The physician's problem was that statistical monitoring of his actions might indicate that he ordered the second test for no reason, wasting money and providing poor patient care. When the lab refused to document that its error required a second test, the existing paperwork made it look as if the second test was ordered for no reason. The physician was also concerned that his patient would be charged for two tests rather than one.

The physician was concerned enough about the possible implications of an improperly recorded second test that he went to great lengths to ensure that the patient wouldn't have "insurance implications" for the incorrect diagnosis. He made sure the hospital record was scrubbed, he sent the patient a letter documenting the case, documented the two test problem in the discharge summary, and called the billing office to ensure that there would be no charge.

Such efforts are expensive. They would not have been necessary if the records were only used for clinical care. They become necessary when records are used for billing, physician evaluation, insurance underwriting, and cost control.

Comments (4)

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  1. Ken says:

    This is just the beginning, Linda. Things are going to get worse. Much worse.

  2. John R. Graham says:

    Although not exactly the topic Linda is addressing, it strikes me that Government could get doctors to buy into state-mandated health IT if adhering to the protocols minimized or eliminated med-mal liability. This would risk swinging the pendulum away from today’s environment of “jackpot justice” too far to the other side, where patients have few or no legal rights. It’s something that we should keep an eye out for. The Obama regime is not going to get doctors to buy into its health IT agenda without a big carrot.

  3. Bruce says:

    The problem is that we keep tryng to solve the problems of a bureaucracy with more bureaucracy instead of with market based insititutions.

  4. Chris says:

    I understand the scenario you are describing and the level of bureaucratic frustration it creates, but I don’t think you really understand that the current situation is worse. Medical records are required by payers to be used for billing now, and the need to send a corrected record is problematic, as are many other situations in this manual process. The insurance companies seem to have little interest in making it run smoother, and hospitals and doctors offices are focused on other aspects of their profession. The process often forces claims to revert to paper when a copy of the record is required to be attached (stapled). Paper claims are less accurate and efficient and take up to 3 times longer to be paid if they do process correctly. And a photocopy of the medical record is in no way superior to an electronic version.

    Electronic claims will be fundamentally less bureaucratic than the current paper versions, but there will still be issues created by the lack of good procedures at either the providers or the payers.