The Business of Healthcare Demands a Legal EHR
The business of healthcare depends upon a hospital’s ability to produce a legal health record, the hospital’s documented set of information for each patient encounter. The legal health record helps the hospital get paid, justifies its performance and improves its performance.
Specifically, the legal health record is a subset of the entire patient database and serves as the legal business record for the organization. The roles of the legal health record are to:
- Support the decisions made in a patient’s care;
- Support the revenue sought from third-party payers; and
- Document the services provided as legal testimony regarding
the patient’s illness or injury, response to treatment and caregiver
decisions (as documented in “Update: Guidelines for
Defining the Legal Health Record for Disclosure Purposes,”
Journal of AHIMA 76, no. 8 (Sept. 2005).
When developing strategies for electronic health records (EHRs), hospitals tend to focus on the undeniable clinical benefits that EHR technology affords. The complementary legal record component of the EHR is often overlooked completely in planning efforts.
Whether your organization is still using paper charts, on the road to the EHR or already at its destination, you need to address the issue of creating and managing a legal EHR as part of your overall EHR strategy.With so many needs and constrained budgets, what are the compelling business reasons for achieving a legal EHR? Other pressing questions include:
- Is a legal EHR worth the time and investment?
- How does a hospital gain organizational support for the legal EHR with so much focus on the clinical EHR?
- What is the experience of organizations that are already working on achieving a legal EHR?
A Key Component of a Complete EHR Strategy
The legal medical record is the complete, unalterable and
reproducible record of each patient’s unique medical care
experience that supports the core work of the hospital’s administrative
and research functions. The hospital depends on the legal medical record for normal business operations. The health
information management department assures its completeness,
accuracy and availability. It is the provider’s source of valid
information on previous patient encounters. It is required
throughout the revenue cycle to determine and support payment.
It is the risk manager’s source data for quality improvement.
It is the record that is released to external requestors or
healthcare payers.
A legal record that is both complete and electronic facilitates and expedites on-site and remote coding as well as the release of information to third-party requestors and others, improving the revenue cycle through enhanced efficiency. The legal-sense EHR complements the clinical EHR; together, they form the foundation of a complete EHR strategy (see Figure 1).
As a hosted solution, the legal EHR can be up and running in months with reasonable start-up and support costs. In fact, a hosted legal EHR provides one of the best “time to value” business cases of any technology investment today; a typical 150-bed hospital that implements a legal EHR can provide a 3-to-1 return on investment within three years.
Building the Business Case
The benefits of the legal EHR are both hard and soft and can be categorized into the following three areas:
- Getting paid more quickly and accurately by improving revenue cycle management;
- Enhancing enterprise performance through better record access; and
- Improving chart security and risk management.
Let’s examine each of these in greater detail.
Getting Paid More Quickly and Accurately by Improving Revenue Cycle Management
The legal record is the basis of all coding activity, providing the
clinical content that will be represented in billing codes and must
be provided, when demanded, to substantiate coding. In electronic
form, it helps coders perform their work more accurately, more
quickly and more completely because it eliminates contention for
the record while it supports coder and physician work flows.
Enhancing Enterprise Performance Through Better Record Access
The legal EHR enables organizations to change the operational
performance paradigm because records can be accessed immediately,
simultaneously and securely wherever and whenever they
are needed throughout the enterprise, using a secure Web browser.
This eliminates competition for the record and gains greater
control over work flow, which drives productivity improvement
across the enterprise.
For the HIM manager, work flow is enhanced by electronic chart management that streamlines completion and sign-off processes and provides on-demand access to charts throughout the hospital. The legal EHR eliminates coding backlogs, allows better control of in-house and remote coders and improves coding compliance and accuracy.
For the business office, the ability to quickly and completely satisfy the requirements of third-party payers reduces denied and delayed claims. Finally, a legal EHR enables physicians to complete and sign off on records in the hospital, in the clinic or at home – wherever it is most convenient.
Improving Chart Security and Risk Management
Without a legal EHR, which by definition is a complete set of specific
information for an episode of service, hospitals may have
trouble substantiating sources and identifying the complete set of
documents required if subpoenaed. A legal EHR can ensure your records are admissible under Federal Rules of Evidence by providing
documents that are date- and time-stamped and have a clear
source of substantiation for all business processes. The legal EHR
creates a system of detailed accountability (e.g., audit logs, digital
signatures, data encryption) that cannot be efficiently matched in
the paper world. Further, a legal EHR provided as a hosted solution
safeguards your records against natural and other disasters,
with built-in redundancy and off-site storage.
Gaining Organizational Support
Once you are sold on the business case for the legal EHR, how do you go about convincing your organization to approve it? Here are some strategies to help you kick-start your legal EHR initiative:
Tie the legal EHR to your organization’s most urgent needs. For example, if you have a coding bottleneck, illustrate how this could be remedied if you had a legal EHR that was completely accessible to coders off-site or to outsourced vendors. Or perhaps you are in pain over high denial rates, lack of filing space or concerns about security lapses. Demonstrate how the legal EHR can address several of your most pressing issues and pay for itself in the near term.
Let physicians champion the legal EHR. The legal EHR has both administrative and clinical benefits for physicians. It can address a quality-of-life issue for physicians, freeing them from the administrative hassle of spending hours in the HIM department completing and signing off on records.
Clinically, the legal EHR provides physicians with immediate access to patient histories. Physicians can begin treatment or care planning immediately rather than having to wait for paper to be delivered to them or sent to the floor.
Demonstrate that you don’t need to wait for electronic record access. If you do not currently have electronic access to medical records, the legal EHR delivered as a hosted solution is a relatively painless way to obtain it. You can be up and running in months, with state-of-the-art security and record safeguards but no capital investment.
Illustrate how the clinical record cycle isn’t designed to support the business office. The clinical world is problem-focused; problems are identified, assessed and treated. The clinical record is a continuum of orders, results, interpretations and actions. There is no concept of record completion – precisely what is needed to expedite the revenue cycle and comply with regulations, and precisely what the legal EHR delivers.
Show how a hybrid medical record is a bigger burden than an all-paper approach. In the pursuit of a clinical EHR, many hospitals end up with a hybrid – part paper, part electronic – medical record. The hybrid record persists as long as systems and processes are disparate – in other words, some paper-based, some electronic.
Hybrid records are often viewed as a necessary evil while on the road to a complete EHR. However, hybrid records in reality present significant problems in that they are harder to maintain and authenticate than even an all-paper approach.
Why Wait?
Hospitals must include a legal EHR as part of their overall EHR strategy. The legal EHR is critical to supporting the business of healthcare by helping you get paid more quickly and accurately, enhancing operational performance via better record access and improving chart security and risk management. And it provides perhaps the fastest, lowest-cost way to give clinicians immediate access to health records. On the road to the EHR, creating the legal EHR today can meet many critical organizational goals simply and easily, paving the way for a complete EHR initiative.
