Locked/Finalized medical records
As we rollout OPEN to additional locations, a feature that we consider critical that is not currently included is lockable medical records. Most of the software programs our managers have used in the past lock medical records at a given point, either at midnight or once the banking is finalized every evening. Once a record is locked, an addendum can be added, but the original record cannot be modified.
Not having the records locked allows for possible fraud, abuse and increased risk should a lawsuit ever be brought against the practice. I could give countless examples but editing the quantity dispensed of a controlled substance is one that comes to mind quickly.
Would there be others interested in supporting this project?
Thanks, Alan
Re: Locked/Finalized medical records
Hi,
Yes, this is an essential part of a modern practice management system.
I think this should be something though that the community as a whole funds (or comes from subscriptions or a development fund) as it is not so much a "nice" feature as a necessity for the community as a whole/
Thanks,
Adrian
Re: Locked/Finalized medical records
I think locking would need to be time dependent e.g. 24 hours after creation.
Note that even with locking support its not a 100% reliable way of preventing fraud. If you want to hide the fact that a controlled substance has been dispensed, for example, you can reverse the original invoice. The dispense record will still be customer's account history, but you won't see it in the patient history.
Reversals remove records from patient history to back out erroneous charges; e.g. a desex operation may have been charged to the wrong patient.
EDIT - it is a straight forward exercise to report on all restricted medications that have been charged. It would also be possible to highlight those instances where a restricted medication has been removed from history via a reversal. With the created by/update by user project, the user that performed the reversal could be displayed.
-Tim
Re: Locked/Finalized medical records
I guess the thing is though that even in the case you outline Tim there is a clear audit log created that shows what was done. And reversing a transaction puts the item back into stock, again the reverse of what fraudulent restricted drug dispensing would be trying to achieve.
I think that an audit logging as well as record locking would be the requirements for this sort of project to get traction.
Re: Locked/Finalized medical records
I added a note to another thread about creating an audit trail for key functions but agree that these go hand in hand and would like to see them added in conjunction with each other.
Re: Locked/Finalized medical records
There are various types of audit trails. The one proposed by the created by/update by user project gives you:
Is this sufficient?
Re: Locked/Finalized medical records
Tim, I have attached a screen shot that Benjamin added back in February to the Created/Updated By thread displaying the audit trail in another program that we use. It is a very good system that we can share more information on if useful.
Would it be possible to not only have a log of who edited records but a display of the revisions made?
Alan
Re: Locked/Finalized medical records
I've started putting together a Medical record locking project here: http://www.openvpms.org/project/medical-record-locking
It needs some input to flesh out the details.
I've added a comment on the http://www.openvpms.org/project/add-created-and-updated-details-primary-... project. Its solving a different problem to an audit trail.
With regards to revisions, there is an extension to the Hibernate persistence layer used by OpenVPMS called Envers. This provides auditing support by tracking all revisions to a table in another table. This will produce a large amount of data compared to just logging who updated what and when.
-Tim