New Malpractice Risks in Your EHR

Ronald B. Sterling, MBA, CPA


January 22, 2019

In This Article

Malpractice Risks in Documenting Care Management Services

Care management services, such as Medicare chronic care management services, are also an area where malpractice risk may be supported or undermined by the EHR. Asthma, congestive heart failure, prostate cancer, and rheumatoid arthritis are examples of chronic diseases that may be supported with care management services.

Such services require that physicians pay attention to how the clinical situation evolves for a patient. The practice or HCO may be responsible for reaching out to the patient on a periodic basis or responding to incoming information about a patient situation. Remote patient monitoring may receive objective information from a web-enabled scale, spirometer, glucose meter, or blood pressure/pulse device, as well as objective information from a health assessment questionnaire application on the patient's smartphone. (Note that HCOs can be compensated for the case management and remote patient monitoring separately.)

A physician's office may receive remote patient monitoring information any time on any day. Typically, the incoming information is analyzed to determine whether the patient requires a response from the organization. For example, a patient-specific setting could trigger an alert to the on-call staff in the event that the patient's weight increased, or the pulse is outside of the patient's prescribed pulse range.

Similarly, the health assessment answers could be analyzed to determine whether a patient is not feeling better today and the HCO should contact the patient. The receipt of the information and notification to the on-call staff as well as the response by the staff is noted in the call management software.

Monitoring Care Management via EHR

Documentation and record-keeping are difficult to do with most EHR systems because care management services dramatically differ from a typical encounter. The trigger for the contact and the continuing effort to address the care management situation may occur over several days or even weeks before the continuity-of-care issue is resolved. For example, the continuing exchanges of information with a patient require connections between the initial contact, such as a reported weight or a health assessment questionnaire, and the response of the HCO.

The response may include a call to the patient, a call to emergency services, or a medication change. The supporting documentation for billing complicates the process because care management revenue is driven on a calendar month, whereas a care management issue may span calendar months.

A new set of ancillary products has come out that are available for use over the Web to manage and document the care management effort. However, patient records that are split between the EHR and care management systems create a new set of malpractice risks and issues.

Practices or HCOs need to ensure that the care management strategy includes a continuing process to manage and address issues on a timely basis.

For example, doctors may not be able to view continuity-of-care information from the care management software within the standard patient medical record. The doctor or staff may have to copy important information from the care management software to provide proper context to the clinical decisions recorded in the EHR, as well as properly document the response to the patient issue in the EHR and the care management services software. The timing and any delays will be available for scrutiny through the audit trails. Therefore, practices or HCOs need to ensure that the care management strategy includes a continuing process to manage and address issues on a timely basis.

Care management-based patient services can trigger an immediate need to engage the patient on a more extensive level with a nurse or physician assistant, or a doctor through a telemedicine visit.


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