electronically stored inforamation Archives

Filters Used to Withhold the Complete Electronic Medical Records

The universal implementation of electronic medical records (EMRs) has become the single most important piece of evidence used in medical malpractice litigation. In response to an EMR Discovery request, healthcare providers use various filters to create useless or hard to read data. Hire an expert to help you weed through the audit trail and to present Discovery requests relevant to the case.

Healthcare providers use filters to withhold electronic medical data when complying with a court order and producing EMR audit trails. During the discovery period, EMR audit trails are commonly used as the single most important piece of evidence in medical malpractice litigation. Knowing evidence is in the details, has led to a chess game of filters proving “Not all electronic medical records (EMRs) productions are created equal!” Figuring out how electronic medical records (EMRs) are filtered is a game changer!

Follow the filters!

When counsel requests a patient’s electronic medical records (EMRs) to review for evidence, the production is often delivered in non-electronic limited formats, such as; scan documents, PDF, or image files. Filters provide limited format productions of (EMRs) therefore it becomes extremely difficult to read and find evidence. Are hospitals and healthcare facilities doing this on purpose? Are they filtering their production to include irrelevant information with very little details about the event in question? They are not making it easy that’s for sure. In truth, they are complying with the court order and producing files that include the electronic health records of the plaintiff. They’re just not providing data information in its completeness. Using filters to produce audit trails is fairly common, but for the injured party and representing counsel these tactics are extremely excruciating. Requesting electronic medical records (EMR’s) is now a challenging game of filtering chess!

Forensic Experts know how to request data essential to your case.

It is quite common that hospitals and healthcare facilities use a variety of filters that will result in an incomplete production. When forensic experts study the production headers they uncover filters that were used to produce an incomplete EMR audit trail. Experts know how to ask for relevant data and dig deeper to find evidence.

Filters, Filters, and More Filters!

Date filters that are applied could exclude alteration of records after the event took place. We suggest the best practice is to use the earliest known date prior to the medical event as a starting point and place the end date the same as the current date of the request. Pushing the end date to reflect the current date will show who looked at the record post-event.
Department filters will only return records that are from one particular department, such as radiology or another department.
Employee filters include specific employees of the healthcare facility. If an EMR record only shows entries related to a physician’s user IDs this can be problematic. It’s important to know all of the names and user IDs of all healthcare providers that visited the patient.
Workstation filters are specific to desktops and/or workstations and could be the cause of incomplete production.
Location filters are used by healthcare providers to limit the full scope of production. It is not uncommon for physicians to access important medical records remotely. This could cause manipulation of data by remote access and filter out data after the event in question.

Enigma Forensics has years of experience developing requests for electronic medical records (EMRs). Our experts know how to ask the right question to retrieve the necessary data to be used as evidence. Save yourself time and expense and hire an expert! Our experts are CISSP certified (Certified Information Systems Security Professional) that provide testimony as a professional witness in a court of law.

Please call Enigma Forensics at 312-669-0333 for a complimentary consultation.

How important are Electronic Medical Records (EMR)?

Have you or someone you know been involved in medical injury or accident? Do you want to win your case? Or…If you’re an attorney and have questions about a case involving medical malpractice, read this blog and contact Enigma Forensics for the “W”.

Were you or a loved one involved in a medical accident or injury? Are you an attorney who is representing an injured client?

If the answer is yes, take immediate action and file a Discovery request or subpoena to access all of your Electronic Medical Records (EMR). Why is this important? In order to prove injury or malpractice and win your case it’s imperative to discover what took place and the actions that caused an event. Your electronic medical records or EMR audit trail will document what transpired. EMR audit trails will include prescriptions, tests, treatments, transfers, operation notes, nurse practitioners and doctors notes and a ton more. Electronic Health Records (EHR) are rich with data information describing the care that was provided and decisions that were made good or bad. Some medical record systems such as Epic have sticky notes that are traditionally not part of the formal patient permanent electronic record. Those sticky notes are required to be stored by the Health Insurance Portability and Accountability Act (HIPPA), but are not part of the discharge report showing the patient electronic medical record history. The data does exist and working with a qualified medical record forensic expert can help you to gain a more complete record of the patient encounter with the health care provider.

What else does Electronic Medical Records (EMR) include?

Electronic Medical Records and the patient medical record audit trail include the original record and will note any modifications. It will also preserve dates, times, who accessed the record and whether the record was printed, viewed, deleted or otherwise modified. Many of the systems today, such as; Epic, Cerner, Meditech, All Scripts and others have reports that can be downloaded to reveal vital information about who has authorization to access and audit electronic health records.

Medical dictations are another vital piece to the puzzle. Dictation files are sometimes sent to third party transcription service providers as raw audio files called WAV files. After the WAV files are received they are typically transcribed to text files and fed back into the electronic health record software system. When modification of the patient medical record occurs after an injury or malpractice took place, comparing the transcription WAV files to the produced chart may help reveal alteration to the patient medical records.

Patient Electronic Medical Charts are often Incomplete. You could lose your case!

When electronic medical record discovery requests are made by plaintiffs to healthcare providers, it is common that the production lacks the complete patient medical record history. Healthcare providers facing litigation commonly provide a minimal amount of data in an often useless format. The form of production is often scanned copies of previously printed our documents or charts. Codewords for health care providers, departments and procedures often make interpretation even more challenging. Having an experience EMR computer forensics expert can help provide a more accurate interpretation of the complete Electronic Health Record (EHR) for the harmed patient.

The Health Insurance Portability and Accountability Act of 1996, or HIPAA is a federal law which requires your medical records to be retained for six years at a federal level. However, most states also have their own medical retention laws which can be more stringent than HIPAA stipulates. Check out this government website to learn about how different states interpret this governance. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html

How important are faxes? This could win your case!

In some cases, Electronic Medical Records (EMR) are faxed to outside providers either to or from your primary physician. Software vendors such as Forward Advantage provide automated faxing capabilities integrating with the existing health care information management systems and patient medical records. It’s vital you request all communication between facilities to help prove or disprove what and when medical knowledge was presented to the provider to make an informative decision relatable to an event.

Let’s say you have already requested an EMR audit trail for a patient. Did you know that the Electronic Medical Records (EMR) audit trail you received contains cryptic codes that you will not be able to comprehend. It’s extremely helpful to request all of the underlying data dictionaries that will provide the definition of the codes used referring to the friendly name, including, the healthcare provider’s name, department, computer used to access the EMR, procedures, treatments, tests ordered, drugs prescribed and lab results.

Did you know that medical data is required to be retained for six years?

Do you want to to win your case! You need Enigma Forensics experts on your team! Hire a professional forensic expert to assist in writing a Discovery request to obtain, preserve and analyze ALL of the electronic medical records and to help you obtain the complete EMR audit trail. We can help uncover the truth of what took place and help tell the court the story about what happened to you or your client.

Call Enigma Forensics at 312-668-0333 to schedule a complimentary phone call to discovery how we can assist.

More about Electronic Medical Records

EMR or EHR what is the difference?

Computer “bots” Used by Insurance Companies

Are Computer “Bots” Making Your Healthcare Decisions?

Enigma Forensics CEO Lee Neubecker and David Bryant from Bryant Legal Group discuss computer “bots” used by insurance companies as a way to underwrite policies and making insurance claims decisions. Bots are now determining how a given claim should be scored. See how ediscovery plays a role in getting success for your client.

The transcript of the video follows

Lee Neubecker: I’m here today with David Bryant from the Bryant Legal Group and we’re going to talk a little bit about health insurance claims in his work, helping people get the coverage they deserve.

David Bryant: Nice to be here, Lee, thanks for taking the time to stop by. We’re seeing a very significant shift in the insurance industry with respect to claims adjudication and claims determinations. One way of looking at how this change is happening is to look at the dollar volume that’s being invested into underwriting insurance policies and making claims decisions. The first metric I’d like to share with you is there is a company out of Europe that did some research on money flowing into what’s now called Insurance Tech, and approximately two billion dollars went into the Insurance Tech arena in 2016. This money is being deployed into not only underwriting, but how claims are made and I think everyone out there is familiar with Watson and the new term artificial intelligence. And how that’s playing out in the insurance industry is that a lot of claims decision-making is being taken out of the hands of individuals and being given to what we’ll call “bots”, robots, or termed a “bot” in tech speak. So these algorithms which will be designed by very bright people, such as yourself, to determine what a given claim should be scored. And if there’s a certain score, then a claims individual will be required to deny that claim. This is problematic for some of the insurance companies because if it’s discovered, through the discovery process, it can wind up hurting them in litigation for bad faith denial of a claim.

Lee Neubecker: So, David, can you tell me a little bit about what you do at the onset of one of your case matters to help make sure that you could argue your case in court?

David Bryant: So there’s really two phases to insurance claims. There’s the appeal process and then there is court. If your claim is denied I can always sue an insurance company in court. Typically that’s in Federal Court. I primarily practice in Federal Court but I do State Court as well. So once I wind up in a court setting I will send a litigation hold letter to the general counsel of the insurance company and that letter secures that all of the data in its electronic format is preserved. So if I want the emails on a particular claim individuals hard drive, that information should be present when I request that information by way of that litigation hold letter. When I do discovery in Federal Court we’re looking for electronically stored information. I’m not looking for paper any longer because we’re looking to get the metadata that’s embedded in that electronic information so we can find out who looked at it, when it was looked at, when it was altered. So, Enigma Forensics having the skill set to be able to determine who touches electronic files, who views electronic files, we will bring in your firm in those circumstances when we want that type of information in litigation. Lee Neubecker: So can you give me an example of when you’ve had to rely upon our computer forensic services for us to help you out with a matter and how that played a role in getting success for your client?

David Bryant: So we handle primarily health insurance and disability insurance claims on behalf of individuals and physician groups. So one of the matters that you handled for us dealt with a disability insurance claim and we were looking for certain key words and key word phrases that were on the server or hard drives of the particular individuals at the insurance company. Being able to cull through all this data is a Herculean task and would be extremely expensive for the defendants. So the defendants will typically go to the Court and say, “Judge, this is going to cost us way too much “money and interrupt our normal course of business. “We don’t want, Mr. Bryant, to have access “to this information or put us through the trouble “and cost of doing it.” I brought in your firm and your services and you were able to explain to the judge that you could do a search of all of the information held by the insurance company and find these key words and submit them to the Court in-camera, so there was no privacy concerns, and report to the judge what your findings were. The case soon settled thereafter.

Lee Neubecker: They usually do. Well thank you for being on the show today. If you need to reach David, his info is on the screen. Thank you.