Recently, at the Kilo Diabetes meeting,
healthcare attourney John Irwin reviewed
meaningful use laws relative to EMR. There was a
stern warning issued by him relative to cloning
of records which must be considered by PM News
readers.
From my experience in reviewing medical records,
it is clear that doctors have fallen into the
habit of ritualistically using the same note for
visit after visit, and on patient after patient.
The same vascular exam, neurologic exam, etc.
Cloning refers to pushing a button and the same
information appears for each visit and eavh
patient. It is an easy form of cutting and
pasting, a macro or keyboard shortcut. As Mr.
Irwin pointed out, "looks great on one
chart...looks hideous when you line up 10
charts."
More importantly, a recent NGS federal website
September 12, 2012 noted "Cloned documentation
will be considered misrepresentation of the
medical necessity requirement for coverage of
services due to the lack of specific information
for each unique patient."
The OIG work plan for 2012, looking at
evaluation and management services, specifically
with referenc to "potentially inappropriate
payments" includes the following: "Medicare
contractors have noted increased frequency of
medical records with identical documentation
across services" (CMS Medicare Claims Processing
Manual Pub 1100-04, ch 12, 330.6.1
Mr.Irwin noted that a recent audit conducted
on "cloned" (the new term by the way is
exploded) EMR demonstrated only 25% accuracy
rate with examination findings recorded exactly
the same for every patient regardless of the
chief examination.
The above cited Medicare work plan notes: "We
will assess the extent to which CMS made
potentially inappropriate payments for E/M
services and the consistency of E/M medical
review determinations. We will also review
multiple E/M services for the same providers and
beneficiaries to identify elctronic heralth
records (EHR)documentation practices associated
with potentially improper payments.
As Mr. Irwin pointed out, "meaningful use" is 2
words."Meaningful use" in the Federal register
is 231,236 words!!
I have personally long been a critique of the
failure to individualize EHR notes with refernce
to medical malpractice issues, as the exploding
or cloning of notes creates the appearance of an
inattentive provider and questions the accuracy
of notes in general. However, the presentation
of Mr. Irwin creates an entirerly new
cnnsideration for those using EHR presently, and
I would ask that you consider this.
Allen Jacobs, DPM, St. Louis, MO,
allennthepod@sbcglobal.net
