Nice approach!
I did some digging and found the following to provide a starting point for those interested.
45 C.F.R. § 164 appears to be one of the current governing federal rules for retention. It does not address specific files and leaves a lot of room for interpretation, so it would be best to have legal advice to make determinations.
The regs establish a 6 year minimum retention period for all digital medical documentation. Audit logs and HL7 files are a part of this.
One interesting aspect I learned when digging deeper was that a patient or their representative (read lawyer) can request audit logs and all inbound/outbound data transmissions as part of a records request and the facility is required to comply or risk penalties for not doing so (irregardless of ability or availability (read deleted)). That is a very clear indication as to how these files are viewed, in my opinion.
It appears that even encounter forms and their code/decision support are considered as part of the record, making it imperative that all versions used in production be retained. The EMR does this by default for current form architecture, but HTML forms require external workflows for retention.
Two more interesting topics apply.
45 C.F.R § 164.524(c)(2)(i) & 45 C.F.R § 164.524(c)(2)(i)
A health care facility must provide the individual with access to protected health information in the form or format requested by the individual.
45 C.F.R. §164.312(c)(1)
Providers of care must “implement policies and procedures to protect electronic protected health information from improper alteration or destruction.”
What we are learning is that some 'standard IT industry methods' may not be legally permissible in healthcare IT. As a result, legal consultation should be an integral part of your IT policy and workflow development.
I've suggested a new track for CHUG regarding legal implications of common workflows. I think at the very least, it would be informative to hear a guest speaker at at key note or session who is an expert on the subject. If you too are interested in this for the next CHUG (too late for this one), then you might want to request it from the CHUG Board.
Excellent discussion!
Posted : September 24, 2019 6:00 am