Recently I spent an hour looking at the paper family practice records for a client from the period 2000-2006, before the advent of electronic health records for that particular institution. It was frustrating to leaf through numerous forms with scribbled notations on them. Some could not be deciphered even by a trained cryptologist. And somehow they all seemed to be randomly organized, with radiology reports and lab results interspersed with chart notes for a particular clinic visit. But it was still possible to flip fairly quickly through the pieces of paper to look for the particular matter that was important to the case I was handling. And each piece of paper was about one thing, as opposed to several.

It is very different to review electronic medical records. Sure, it’s nice that they are all readable. But depending on what button was pushed when they were printed, the records come out in many different formats. Lab results from different admissions or office visits may be printed sequentially, so you have to carefully look at dates to be sure you are matching the right lab report to the visit in question. The records also use the “copy and paste” routine, so the identical paragraph about the patient history will be repeated in the chart note for every encounter. Often this means a change in that history is never recorded, since it is so much easier to just push one repeat button.

Part of the problem for older attorneys like me is that our brains aren’t trained to review documents as they scroll past you on the computer. And when you see something that triggers a question about something else, finding that additional record or report may mean endlessly scrolling back and forth. That often requires printing out the electronic records, thus negating the advantages of a “paper-less” office. Then at least you can use yellow stickies to mark your place as you flip back to a different part of the record. There may be a way to flip back and forth in an electronic record, but if there is I haven’t figured it out.

The advent of electronic records has also led to the need to monitor when changes might have been made in the records. The old concept of having a “questioned document examiner” review paper records to see if something was inserted or added is out the window. Now you need to do an audit trail which tells you exactly which provider looked at the record at a particular time and exactly what was added or changed and when that occurred. Because the records can be printed out in so many different ways, it may also require that you actually sit at a monitor to see what the records looked like to the provider using the system, and understand how the various pull-down menus are used.

This blog has other articles about the perils of electronic records, and every medical journal now seems to have some adverse comment by nurses or physicians. But there are clearly advantages, and it is clear that electronic records are here to stay so attorneys have to devise ways to effectively review them when they analyze a potential medical negligence claim.