Can we trust the Records?

Corruption has gridlocked improving patient safety by using electronic medical records to hide preventable patient crippling and deaths. That corruption has evolved into everyone's electronic medical records.

Blocking public awareness and access to patient's medical record "Electronic Medical Record Chronological Audit Report" is one of the many dirty games hospitals are perpetrating. 

Push-back from hospitals, the financial winners of falsifying these records are well aware of the implications of you seeing your audit report.  The third, and most contentious, area of concern is  with EHI access logs. The proposed legislation calls for a single log to be created and provided to the patient, that would contain all instances of access to the patient’s EHI, no matter the system or situation. (access report)

Currently, Patients/medical harm victims/families need their counsel to demand these reports, also demand copies of all journal records and files related to the patient chart.  These items need to be provided as a system-generated binary and copies should also be provided from backups created when (and since) the care being litigated was performed. These will document if the record was altered.a real knowledgeable IT person can alter the journals... though he/she typically won't have access to the back ups.

Refrence:  Integrity of the Healthcare Record: Best Practices for EHR Documentation

(400,000 deaths a year, even more left disabled)

 Black Box of medical records
See how much resistance the medical industry have to supplying patients the very thing that would show the records to be credible .... or not.

October 14, 2011 Senate Bill 850 triggered after a Stanford hospital was caught (allegedly) going back and falsifying a patient's records after the patient died in their care.

In November, 2012, John Natale, M.D., of Chicago, a cardiothoracic and vascular surgeon, went to federal prison on charges of falsifying surgery records.

(More info below)
According to the author, however, despite these federal 

It is non-negotiable, patients will have full access to this clinical audit report 

Healthcare is the only industry who have consistently run outside the basic laws of business.  Medical records have become so corrupt, they don't even meet the integrity requirements of the Federal Rules of Evidence in court

 2014 study finds less than half of patients medical records are trustworthy, yet hospitals profit from the fact they are not held accountable for the integrity of their own business records, while botched care is the number three cause of patients death. It is all about lying to the public!

Misplaced reliance on inauthentic medical records has implications beyond their admissibility in court. Inaccurate record keeping compromises the medical record and can lead to adverse patient care Certainly there is a looming evidentiary defect undermining the very purpose for the records’ existence pdf

I hear ya! .... your right, ....not only is it barbaric to falsifying medical records to cover-up harm, it is punishable by prison.
(1035 False Statements in Health Care Matters)
 Whoever, in any matter involving a health care benefit program, knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact; or makes any materially false, fictitious, or fraudulent statements or representations, or makes or uses any materially false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or in connection with the delivery of OR payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 5 years, or both.

" Association of American Physicians and Surgeons tells the Court that the criminalization of language used in medical reports will have a profoundly chilling effect on the practice of medicine."

Californa bill comments: 850

According to the author, existing law regarding the accuracy and integrity of medical information was enacted prior to the development of electronic health records.  ........Most notably, while alterations and deletions in paper record are generally visible upon inspection, the same is not always true of medical information recorded and stored electronically.          
Electronic alterations and deletions are not obvious to the 
          naked eye, and in the absence of technology that can detect
          alterations and deletion, such changes may leave no trace at
          all.  Accordingly, this bill requires that any alteration or 
          deletion in electronic medical information system be "recorded 
          and preserved" in order to better protect the integrity of 
          electronic medical information.  The bill would require not only 
          that the change be recorded and preserved, but also that the 
          record contain specified information, including the identity of 
          the person who accessed and changed the medical information, the 
          date and time the medical information was accessed, and the 
          change that was made to the medical information. 

           Interaction with Federal Law :  Federal regulations set forth
          standards that must be used whenever health information is
          electronically created, maintained, or exchanged.  For example,
          federal law requires that the appropriate date, time, patient
          identification, and user identification be recorded when 
          electronic health information is created, modified, accessed, or 
          deleted, and that the record must indicate which action or 
          actions occurred and by whom.  In addition, federal law requires
          that a "hashing algorithm" that meets standards set by the
          National Institute of Standards and Technology (NIST) must be
          used to verify that electronic health information has not been
          altered.  (45 CFR Section 170.210.)


          regulations, existing systems only make it possible to decipher 
          alterations or deletions by examining a separate "audit trail," 
          also known as an "access log" or "audit log."  That is, federal 
          law requires a system to record changes, but the change is only 
          recorded in the audit log and does not necessarily appear on the 
          face of a record and or in a user friendly format.  Although the 
          author originally sought to address this issue as well, the bill 
          presently would not require that the information be provided to 
          the patient in a more user friendly or readily apparent format.  
          Rather, like federal law, this bill would only require that
          changes and alterations be recorded and preserved.  It may still
          be the case under this bill and under federal law, depending on
          the kind of system used, that those changes and alterations can
          only be determined by requesting an audit log, which may or may
          not be understandable to the patient.

           Recent Federal Draft Regulations Relating to "Access Logs" and 
          "Access Reports"  :   Since this bill was introduced, the United 
          States Department of Health and Human Services (HSS) proposed 
          rule changes to modify the Health Insurance Portability and 
          Accountability Act (HIPAA) Privacy Rule and the Health 
          Information Technology for Economic and Clinical Health (HITECH) 
          Act.  These proposed changes also address the manner in which
          changes in health information records are recorded and
          disclosed.  Among other things, HSS is proposing a rule change
          that would provide individuals with a right to receive an
          "access report" that indicates who has accessed the electronic
          information.  The proposed rules would apparently distinguish
          between "access logs," which would consist of the raw data that
          the system collects each time a record is accessed, and an
          "access report," which would be "a document that a system
          administrator or other appropriate person generates from the
          access log in a format that is understandable to the
          individual."  (See "HIPAA Privacy Rule Accounting of Disclosures 
          Under the Health Information Technology for Economic and 
          Clinical Health Act," Federal Register, Vol. 76, No. 104, May 
          31, 2011, p. 31436.)  However, these changes, even if they 
          occur, would not be inconsistent with this bill, since this bill 
          speaks to the recording and preserving of alterations or 
          deletions in the record, and not to the format in which 
          information shall be presented to the patient upon request. 

           ARGUMENTS IN SUPPORT  :  The sponsor of this bill, the Consumer
          Attorneys of California (CAOC), argues that this bill will help
          to prevent medical errors and improve the quality of patient
          care "by ensuring that electronic medical records accurately
          reflect a patient's medical treatment and history, by preserving
          a record of any modification or deletion made to a patient's
          medical record."  The purpose of the bill, according CAOC, "is
          to ensure that information that was previously accessible to the
          patient in a paper format continues to be available to the
          patient in an electronic format."  CAOC also points out that
          recent federal health care reform, enacted in 2009, gives
          providers incentives to switch to "certified" electronic health
          record systems, so that by 2015 most if not all providers will
          use electronic systems exclusively.  However, while CAOC 
          recognizes the potential benefits of this change, it contends 
          that "some health care providers have unscrupulously taken 
          advantage of these shortfalls to cover-up errors by modifying or 
          deleting earlier entries," citing, for example, a case against 
          Stanford Hospital where such a cover-up of mistakes allegedly 
          occurred.  CAOC notes that federal law already requires that 
          electronic health record systems have the ability to record 
          changes in a medical record, and states that "this bill simply 
          requires actual recordation and preservation of the change." 

Winning any medical malpractice claim is difficult for the simple reason that the juries tend to favor physicians. This is true no matter how egregious the malpractice. The judge (and standard jury instructions) tend to push the case in the direction of a professional debate between expert witnesses – a losing formula for the plaintiff. 
By proving a physician falsified the medical record (and then lied about it!), the plaintiff can change the nature of the trial from a medical “debate” to medical “cover-up” –- a winning strategy. 

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