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Ehrs and Malpractice A vision of tomorrow: Honoring patient choice BY RICHARD A. SZUCS, MD RRAMIFICATIONS Richard A. Szucs, MD, is a radiologist with Commonwealth Radiology, P.C., and president FALL 2013 n VOLUME 19 n NO. 4 WWW.RAMDOCS.ORG of the Board of Trustees of the Richmond Academy of Medicine. EHRs and tarting a conversation about end-of-life care can be dif- malpractice ficult, whether we are physi- BY CHIP JONES cians, patients, family mem- Secours, HCA and VCU, to advise the participants that the Richmond Sbers, religious and community leaders us regarding how we, working with Academy of Medicine assume a lead- or other professionals. It is, however, others, can promote and encourage ership role as catalyst, convener and imperative that these conversations advance care planning (ACP) in this organizer of a community-wide effort take place. And, once they occur, it is community. The core group agreed on advance care planning. Everyone equally critical that caregivers honor that adopting a uniform approach agrees that advance care planning is a patients’ choices. When no conversa- to ACP across the healthcare mar- lifelong process, best begun before a tion occurs, families and caregivers ketplace was essential for increasing crisis develops. are left making decisions that may awareness and engagement. We shared the outcomes of the As a physician, any discussion of not reflect what a patient desires. In late May 2013, the Acad- conference with health systems, electronic records should start with two The Richmond Academy of emy sponsored a community-wide Secretary of Health and Human words: “audit trail.” Here’s why: Medicine champions advance care educational conference where 100 Resources Bill Hazel, Senator Mark According to the July 2013 issue of the Virginia Medical Law Report, lawyers planning, hospice and palliative care. healthcare professionals from the Warner, and the Virginia Center for across the commonwealth are busily Within the last two years, we have health systems and the wider com- Health Innovation. We were encour- adapting to the brave new digital world of developed a core group of healthcare munity came together to learn about aged to continue to do the work that patient information. professionals, including hospice and best advance care planning practices. brought the healthcare community It begins with language itself, one palliative care specialists from Bon There was unanimous support among “Vision,” continued on page 2 Norfolk lawyer told the publication. “There’s a whole new lexicon, a new language we have to speak.” Lawyers also are learning to dig things We want you to take it home and make it your own: up in new ways as they perform discovery in malpractice cases, giving up the “stray facts and telling details” they used to The age of the electronic find in various folders and log books in hospitals and doctors’ offices. Now lawyers must obtain screen health record shots of pull-down menus and tabs for extra details in the electronic record. BY ISAAC L. WORNOM III, MD FACS Another personal injury lawyer called medical records “the skeleton on which hen my son Chris was a rising junior at my case is based.” Douglas Freeman High School, we went Do you have any “skeletons” together to an assembly to get the new lurking in your data closets? For good laptop that Henrico schools gave to every housekeeping tips, check out this W rising high school student. www.fierceemr.com report (Oct. 2, 2013), “EHRs Won’t Decrease Malpractice Risks, Dr. Pruden, the excellent principal of Freeman at the time, Premiums.” stood in front of us and told the students that he wanted Though electronic records may help to them to take those computers home and in the two weeks improve patient care, the report cautions before school started, “make them their own.” providers not to “expect such systems Well that is just what Chris and his computer-savvy to lower their malpractice premiums, as friends did. By the time school started, those little laptops EHRs can create new problems and make had 10 times as much RAM and more new programs on it harder to defend against such claims.” them than you could shake a stick at. That did not last. The Some potential problem areas: l Disabled clinical decision support county figured out what had happened and collected the alerts that, if used, could have caught a laptops and returned them to their original configuration problem. and made lots of rules to keep it from happening again. The l Auto complete functions that fill in students who made the changes became the go-to people for data incorrectly. computer problems at the school. l Sharing of passwords, so that the physicians look like they’re viewing “Health record,” continued on page 3 the chart when they actually are not doing so. l Sloppy documentation, such as incorrectly entered data. 4 6 8 EHRs also create audit trails, according Whither EHRs? Technology Rules of E-road to the report. And guess who likes audit and social trails? Not just the IRS! distancing Chip Jones is RAM’s communications and marketing director. 2 FALL 2013 “Vision,” continued from page 1 POST pilot projects. markers for success of this work. Recently, we invited Central Once clinical implementation is un- together, speaking in one voice, in sup- Virginia health systems to join us. derway, we will launch a major grass- RRAMIFICATIONS port of honoring a patient’s choice. We cannot do this work alone, but roots effort to reach citizens through RAMIFICATIONS FALL 2013 Now we are ready to take the next with their support and guidance we a marketing campaign. Community VOLUME 19 n N O . 4 logical step to support system change, can be a collaborative partner for a stakeholders, including religious, civic, advocacy and education around community-wide initiative. Health legal, and business organizations, will advance care planning throughout systems joining us would agree to a be invited to join in our efforts. PRESIDENT Central Virginia. The Academy common emphasis on improving the No doubt, all of this requires Richard A. Szucs, MD desires, as convener and coordinator, conversation between patient and significant resources. In the spirit of co- VICE PRESIDENT to launch an Advance Care Initiative provider, not only in word but also in operation and leadership, the Academy Peter A. Zedler, MD built upon the proven concepts of action. Such a commitment requires has committed $100,000 in startup TREASURER Respecting Choices®. Respecting a collaborative partner to invest in funds provided all health systems join. L. Randolph Chisholm, MD Choices is a program started more technology that adequately stores Health systems were asked to contrib- than 20 years ago in LaCrosse, and retrieves advance care planning ute $40,000 a year for two years. SECRETARY Joseph S. Galeski III, MD Wisconsin, to help patients articulate documents; to invest in the training We will keep you informed of our their choices about end-of-life care of professionals and laypersons; and conversations and efforts. EXECUTIVE DIRECTOR Deborah Love and put in place systems to ensure to devote the organizational resources It has been an honor to serve that patients’ choices are known needed to implement new programs as your President for the past two EDITOR and respected. Their experience has and services. years. I believe that this initiative is Isaac L. Wornom III, MD shown that this results in improved To guide the work of this initia- the most important thing I have had COMMUNICATIONS AND quality of life and improved patient tive, collaborative partners will the privilege to lead. I believe it will MARKETING DIRECTOR and family satisfaction with end-of-life appoint two or more professionals to result in a significant improvement in Chip Jones [email protected] care. Their methods have been widely a community steering committee that the quality of end-of-life care in our (804) 622-8136 recognized and replicated at many will oversee the project. The steering community. Because I believe this so other sites regionally, nationally, and committee will articulate the goals strongly, I intend to remain involved ADVERTISING DIRECTOR Lara Knowles internationally. Respecting Choices and objectives, select pilot sites, and with the project. I invite you to join [email protected] is also the platform behind Virginia’s define achievable and measurable us as we move forward. R (804) 643-6631 ART DIRECTOR Jeanne Minnix Graphic Design, Inc. [email protected] Children’s Cancer Hospital in Egypt (804) 405-6433 made it possible to extend the hospi- United2Heal: Your tal’s operations by providing 500 new RAM MISSION The Richmond Academy of Medicine beds. Fellow VCU sophomore Karima strives to be the patient’s advocate, Abutaleb and I have had the oppor- the physician’s ally, and the supplies can help! community’s partner. tunity to visit the hospital in Egypt to BY ALBARA ELSHAER evaluate the shipment’s impact and ON THE WEB receive feedback on how to improve www.ramdocs.org future shipments. Published quarterly by the If we can do all this with the help Richmond Academy of Medicine 2201 West Broad Street, Suite 205 of key partners in the U.S., imagine Richmond, Virginia 23220 how many more people we could (804) 643-6631 serve if others got involved? Help us Fax (804) 788-9987 help others by donating excess medical Non-member subscriptions are supplies, surgical kits and even simple available for $20/year. The opinions expressed in this items such as examination gloves. We publications are personal and do not also could use more volunteers to help constitute RAM policy. © Richmond Academy of Medicine sort the supplies. Please visit our web- site, www.united2heal.org, to see our Letters to the editor and editorial past events, to contact us, or to make contributions are encouraged, subject to editorial review.
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