EMR and Deposition

 The day before yesterday attorneys deposed me for the first time since I started using an EMR (electronic medical record). I appeared as a fact (not expert) witness in a case involving litigation by a patient against another party. I had already provided extensive records to both plaintiff and defense attorneys, including faxes of my old paper records, copies of computer files on CD, and two different attempts at providing the patient's record from the EMR, at least one of which was almost certainly incomplete.

Because the EMR exists in the cloud I can access it from anywhere I have a browser and Internet connection. But since I do not "possess" the record I cannot comply with the usual subpoena that requires the witness to bring such an item to the deposition. Instead I faxed the attorney who apparently most wanted to depose me a letter informing him that I would need a browser and Internet connection in order to access the record during the deposition.

The attorney had me access the patient's electronic medical record prior to swearing me in. While all the attorneys looked over my shoulder I clicked through much of the record, attempting to print as much as possible of what appeared relevant. Satisfied and with multiple stacks of records in hand the attorneys proceeded to interrogate me.

Only one real problem surfaced: Attorneys can now automate printing of what used to be called Bates numbers on printed records, making it much easier to get everyone -- literally -- on the same page. Achieving this with a browser might require a different approach, such as sending the same image to a screen in front of each person.

Although everyone seemed happy with this solution I maintain that only through use of a browser can we access the complete record. Paper copies do not accurately represent the electronic medical record, if only because no electronic signature appears with each progress note. Also, I frequently save .mp3 files of voice mail messages to the record, and of course these cannot be printed on paper. Finally, relationships among different data sets cannot be represented accurately in a stack of paper copies.

I predict that someday the judicial system will have to adapt depositions and trials to allow for viewing such "exhibits" in real-time on a computer screen. Likewise, expert witnesses will require access to medical records via the Internet instead of attempting to understand the case by reading paper copies. For this to happen vendors of electronic medical software, especially cloud-based services, must provide temporary read-only access to a single patient's record. Currently my vendor does not have such capability.

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