June 19, 2020

This post is Part 9 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Final Notes

The goal of this 9-part series is to stimulate the plaintiff’s teams’ thinking about additional sources of eDiscovery. If the plaintiff’s team is unaware that device data exists and does not specifically ask for it, they are unlikely to receive it. If the judge and defense team are not properly educated about the patient’s right to access this data, (data that is used, in whole or in part, to provide patient care), this eDiscovery will not be accessible to the plaintiff. By requesting eDiscovery with sound explanations as to why the plaintiff should have access to this infor...

June 12, 2020

This post is Part 8 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Bed Alarms, Smart Beds, Smart Mattresses

Data from the bed and bed alarms may also be preserved. Hospital beds, mattresses, and bed alarms incorporate technology, utilize sensor networks, and mechanize traditional procedures, which are commonly associated with electronic medical records and monitoring systems. In other words, if a patient tries to climb out of bed, the bed alarm may send an alert to the central nursing station. If the bed alarm and central nursing station are properly associated with the electronic medical record, the alarm data will be recorded on the audit trail.

Hosp...

May 28, 2020

This post is Part 7 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Telemedicine Consults and Monitoring

The use of Telemedicine or Telehealth significantly increased in the past year because Medicare[1] and many other private insurances increased access to telehealth visits. Care rendered by both physicians and non-physicians may be preserved – and discoverable. Remote monitoring of critical care patients is an increasingly common cost cutting method being implemented in many hospitals.[2] Telehealth allows for patients at multiple units to be remotely monitored at a separate site. Data transmitted back and forth and communications regarding patient ca...

May 21, 2020

This post is Part 6 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Pitocin Pump Case Study

The labor nurse’s medical record entries on the flowsheet documented a completely benign course of labor in which she started the Pitocin infusion at 09:39 and kept the Pitocin infusing at 2 mu/min through delivery at 12:41. Inconsistent with the nursing flowsheet’s representation, the electronic fetal monitoring tracing showed increasingly serious tachysystole with poor resting tone between contractions more than an hour prior to 09:39, and a fetus who became increasingly intolerant of this harsh environment. The inconsistencies made the attorney’s team suspicio...

May 15, 2020

This post is Part 5 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Mechanical Intravenous Infusion Pumps

Mechanical infusion pumps are another source of information that may not present in the medical record except for an audit trail of device data.

An infusion pump is a medical device that delivers fluids, such as nutrients and medications, into a patient’s body in controlled amounts. Infusion pumps are in widespread use in clinical settings such as hospitals, nursing homes, and in the home. Many infusion pumps are equipped with safety features, such as alarms or other operator alerts that are intended to activate in the event of a problem.

For exampl...

May 7, 2020

This post is Part 4 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Pulse Oximeter Case Study

Pulse oximeters are one of the most common biomedical devices used in performing routine patient assessments. Pulse oximeters typically record and store oxygen saturation measurements and pulse rates at intervals set according to the facility’s or unit’s policies and procedures. The pulse oximeter device software also offers the capability of having ranges set for alarms, so that when the vital signs or other data being measured, exceed the range set, alarms will sound in the patient care unit. When alarms go off during patient care, the identity of person res...

May 1, 2020

This post is Part 3 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Why should the Plaintiff have Access to Device Data?

HIPAA states that the patient should have access to “Records That Are Used, In Whole Or Part, By Or For The Above Provider To Make Decisions About The Above Individual.”[1]   Device data certainly fits within that description of information.[2]  The information blocking provision of the Cures Act, (section 4006(a)) supports both the patient’s and/or his designee’s access to the patient’s electronic health information.[3]  Further, the standard for audit trails, ASTM e2147, gives patients access to audit trails...

April 27, 2020

This post is Part 2 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

What is Device Data?

Biomedical devices are commonly  integrated into electronic medical record systems as a means to simplify workflow and actually enhance the value of the EMR and its adoption by clinical staff. When deployed, vital signs data are automatically sent from biomedical devices directly to the nursing documentation system. The nurse can focus more on direct patient care by quickly validating the vital signs data in the EMR and submitting them to the patient’s record. Elimination of manual entry reduces errors in data entry, increases clinical satisfaction and improves...

April 24, 2020

This post is Part 1 of a series based on Nursine Jackson’s article, “What about that Device Data?”.

Device Data Case Study

A nurse in Tennessee received a communication that one of her patients was in radiology waiting for a CT, but too stressed to hold still for the study. Her patient’s physician had issued an order for a sedative, Versed, to help her through the examination. This nurse went to the cabinet to retrieve the medication ordered. She typed in “V E” and a medication name autofilled with “VERCURONIUM,” to which the nurse hit “accept.”

Vercuronium is not Versed; Vercuronium is a paralytic agent used by anesthesia personnel and used only when a patient has ventilatory sup...

April 8, 2020

Birth injury cases are difficult enough due to the nature of the events. From an electronic discovery perspective, these cases can be complex due to an extended discovery timeline and the probability that several EHR systems were involved. EMR Discovery supports plaintiff attorneys with eDiscovery cases and has compiled a list of birth injury-specific considerations.

  1. Preservation letter: If you are waiting to file or request discovery until the end of the Statute of Limitations, you should consider sending a preservation letter. Some states have a 10-year Statute for minors however, some federal requirements mandate only 5 years of data retention for hospitals. This disparit...

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EMR Discovery offers healthcare litigation support services for plaintiff medical malpractice firms. EMRD's expertise includes EMR/EHR, Audit Trails, healthcare information systems, eDiscovery support, and analytical document review solutions. EMRD delivers a customized approach to fit each unique case.

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