Access to electronic medical records is critical to gaining a complete understanding of a patient’s medical history, even after they have passed. And while Ohio law states that “…[A] coroner, deputy coroner, or representative… may request, in writing, to inspect and receive a copy of [a] deceased person’s medical and psychiatric records,” the process for requesting and obtaining medical records has proven to be onerous and burdensome for local coroner’s offices.
The records, often only available as physical paper files, need to be copied and transported to the coroner’s office which can be expensive and time-consuming, while also potentially leading to problems such as loss and human error. In addition, coroner’s offices may make several records requests to multiple hospitals and systems each day, sometimes resulting in duplicative transport costs and producing more chances for error each time a request is made.
Andrea Hatten, Chief Administrator for the Hamilton County Coroner, describes this process as particularly time-intensive.
“The former process by which we requested and received medical records was very arduous, time consuming, and not least of all, environmentally unfriendly,” Hatten observed. “Our investigative staff would spend time driving around the county to retrieve medical records only to return to the office with volumes of paper that would need to be reviewed page by page.”
That’s where The Health Collaborative (THC) and Epic software come in, with a technology solution specifically tailored to address the inefficiency and risks of the current process and provide a sustainable solution.
Epic is an Electronic Health Record (EHR) software system used by the six largest of Greater Cincinnati’s regional hospital systems and many of their employed physician practices, as well as a few independent healthcare providers. The Health Collaborative’s Regional Epic Services provide a platform of programs that allow hospitals across Greater Cincinnati & Dayton to work together to optimize the use of Epic regionally. The partnership enables these organizations to analyze Epic-enabled clinical and business processes, address deficiencies and define efficiencies, establish community standards and strategies, and implement them across systems. Members gather periodically to exchange best practices and provide education through user group meetings and workshops.
For this project, THC worked with providers to design a process to allow coroner’s offices access to specific patient records. With special programming, the newly-implemented system now allows approved and trained personnel from local coroner’s offices to access deceased patients’ electronic medical records through special access to only that segment of the Epic record. These are the same patient records that were previously provided, most often, as a printed paper record.
“This process is a great example of working smarter and not harder, and with an ever-increasing caseload, that is exactly what we needed.”
– Andrea Hatten,
Hamilton County Coroner
Hatten says The Health Collaborative helped facilitate this needed change, supporting regional efforts from start to finish.
“The guidance and support from The Health Collaborative made this all possible. Susan White [Director, Regional Epic Services,] provided contact information to me for the various hospitals, prefaced my communications with those very contacts and then followed up with me on many occasions to check the progress of my communications,” Hatten said. These services were also provided to the Butler County Coroner’s Office, with similar reports of satisfaction as a result.
In some cases custom solutions needed to be developed in order to meet the needs of both hospital systems and coroner staff. For one hospital in particular, the solution was to ensure that each coroner’s workstation meets Epic hardware standards and to have software installed that allows access to the so-called Epic Production System. When a coroner user logs in, they are automatically directed to the “In Basket” (Epic’s internal email) screen. While they are not able to navigate freely within Epic, they can access assigned patient records through a link contained in an In Basket message. These patient links are assigned to them by medical records personnel or selected floor nurses at the patient’s point of care.
In addition to efficiency, safety protocols have been implemented to ensure security and appropriate access to a given decedent’s records, such as a 30-day access expiration on each assigned patient account, and using demographic patient identifiers to access the record.
The results of these changes are far-reaching for both coroner’s offices and healthcare providers at hospitals.
Hatten continued, “This new process allows us to electronically access the exact records we need, secure them electronically, and then refocus our efforts on the other facets of death investigation. Simply put, we are more efficient with our time and resources. This process is a great example of working smarter and not harder, and with an ever-increasing caseload, that is exactly what we needed.”
It’s one more way The Health Collaborative is helping to make the healthcare Triple Aim of healthier people, better care, and lower costs a reality for all in the Greater Cincinnati/Northern Kentucky region.