This is normal behavior for the EMR. While it MIGHT seem logical to reference the most recently entered value in any update, it is important to look beyond the data and into the realm of medical decision making.
Example:
One morning, Dr. X prescribes penicillin to the patient but does not finish the note until later in the day. Inside the same EMR data base, Dr. Y sees the patient for an allergic reaction to penicillin and documents/signs the note before Dr. X signs their note.
If Dr. Y's note updated Dr. X's note, it would appear that Dr. X ignored the fact that the patient was allergic to penicillin and prescribed it any way, which is not the case at all, but the very solid case the malpractice attorney would push for the ultimate payout (little of which the patient would actually receive, of course).
Alternatively, what if Dr. Y entered erroneous information (wrong chart) and Dr. X based their ongoing medical decision making on that 'new info'? Patient harm could result from this scenario.
Lastly, what if Dr. Y was seeing the patient while Dr. X signed their note. Dr. Y. was nearing the end of their visit and signed the note, not noticing that immediately prior to signing, the patient's potassium was 'updated' to 6.8 (medical emergency) and let them walk out the door? What if they called an ambulance to take them to the ER (needs heart monitor during transport) and the patient actually had a normal potassium today?
Hopefully you get the picture. It SOUNDS ideal to share information in documents during the udpate, but the reality should be clear - it is a terrible idea.
In an effort to mitigate the risk involved to all parties, the EMR takes a snap shot of the data at the time the update was started and does not natively interact with any newly stored information outside of the update regardless of the data's date. It is a very important safeguard whose only real downside is as you describe.
Fortunately, there are workarounds, such as one mentioned in Greg's post. Hope this further's understanding as to why it is the way it is. Likewise, by understanding the above, the use of the workaround should be employed only after careful consideration of the impact and potential increase in risk liability for both the patient and the provider.
Posted : July 26, 2017 2:13 am
