Expert Witness Electronic Medical Records

Finding an Expert Witness in Electronic Medical Records – such as one who understands HITECH Act Audits, Forensic Review in HIPAA Breaches, Medical Malpractice, or Qui Tam False Claims Act is important.  Based on our experience digital forensic reviews of electronic health records can be an invaluable discovery tool in medical malpractice cases and HIPAA Privacy Breach cases.  The U.S. Government has paid out $billions to encourage the adoption of electronic health records.  Now, there are mandated requirements that ensure tamper-proof records and audit logs, along with clinical decision support and other areas that can be used by a skilled expert to determine the veracity of the patient chart.  The patient medical records and its accuracy can be determined many times based on specific discovery strategies.  Conversely, a skilled expert can be useful in rebutting the testimony of another expert as to whether the audit method was reliable.

Electronic Medical Records are the system of record for most patient diagnosis data, physician progress notes, and procedures.  This is especially true in the U.S. healthcare system after 2011 when the first incentive payments for Meaningful Use of Electronic Health Records were paid.  The requirements for healthcare providers to attest for meaningful use with electronic medical records are detailed and complex.  A summary of the requirements is in the Code of Federal Regulations (CFR) § 495.22 Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs for 2015 through 2018.

Electronic Health Record Forensic Audit Expert
Michael F. Arrigo Electronic Health Record Forensic Audit Expert. Contact Here.

EHR Forensic Audits

As a result of the HITECH Act of 2009, the majority of hospitals and outpatient facilities use EHRs.  The quid pro quo to access a portion of the $30 billion in stimulus funds is that hospitals and physicians must attest under penalty of perjury that they have become meaningful users of EHRs.  The EHR has anti-tamper capabilities.  A skilled Expert Witness in Electronic Health Records can use this as a forensic platform to extract data for fraud, medical malpractice, and Qui Tam False Claims Act cases.   Audits may reveal whether the eligible hospital or eligible provider properly configured their system before petitioning for stimulus funds.  A false statement may lead to a qui tam investigation by the Government, whether DOJ, HHS OIG, or HHS OCR.  HIPAA Breaches have also been sentinel events that trigger Federal Audits.

Medical necessity is determined by clinical documentation.  How procedures are documented and coded and ultimately reimbursed will depend on two things: 1. The system of record that contains discrete data supporting the documentation, better known as an electronic health record (EMR) or electronic medical record (EMR) 2. The quality of the coding which will soon be based on ICD-10 CM  for all HIPAA Covered Entities when diagnosing patients and ICD-10 PCS for all HIPAA Covered Entities who bill for inpatient medical procedures.

Forensic audit capabilities include:

  • Forensic audit methodologies that meet generally accepted Standards for expert reports
  • Audit log subpoenas
  • Verification that audit logs are complete and meet the Standards
  • Audit log verification
  • Patient documentation review in comparison to audit logs
  • On-Site inspection and review of live electronic medical records to verify that the live data matches the logs and the produced documentation
Electronic Medical Records
Attestation, Meaningful Use Audit Defense, Inpatient, and Outpatient, Remediation Strategies

Electronic Health Record Standard Configuration and Implementation

  • Electronic health records must be properly configured with clinical decision support and other alerts according to HITECH Act Standards
  • Electronic medical records require specific Technical Safeguards to comply with the HIPAA Privacy Rule and HITECH Act Standards
  • Implementation of an E.H.R. to meet both Standards and specific needs of the health care provider require an understanding of regulations and actual use of the solution in the medical setting for the physician specialty or hospital

Electronic Health Record Selection and transition

Our team can assist with :

Team qualifications

  • Led multiple electronic medical records (EMR) / Electronic Health Record (E.H.R) implementation projects for hospital systems.
  • Create and maintain training courses to further the technical education of customers in software development practices and reporting methodology.
  • Advising EMR vendors on preparation for ONC ATCB Certification and proctor examinations for Meaningful Use Certification of elctronic medical records
  • Deep understanding of Meaningful Use of EMRs

Our experience includes full life cycle implementations of electronic medical records including:

  • Epic
  • Cerner
  • NextGen
  • athenahealth
  • Allscripts
  • McKesson
  • Meditech
  • eClinicalworks (eCW)
  • eMDs
  • AdvancedMD
  • eCast
  • Varian
  • Elekta

…and a host of oncology-specific systems.  Our partner acted as the EHR technical advisor to American Society of Clinical Oncology (ASCO) for five years. Leading Systems:

  • ARIA (Varian)
  • OncoEMR (Altos Solutions)
  • IKnowMed by US Oncology (McKesson Distribution)

Small oncology systems

  • Rabbit E.H.R.
  • iClinic Ambulatory (MDLand)
  • MedSymEHR : Multispecialty, (MedSym Solutions)
  • Oncology System – EHR/CIS (Integrated Clinical Care)

  • Chemotherapy administration system; not an EHR but has an interface with GE & Allscripts
  • We are familiar with these systems but we have not implemented these systems
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