We have been fighting this battle for many years and are very much in agreement with you. When we first implemented PCS in 2000, if one user documented, and another changed or added something, both users were listed, and the changes were obvious. Somewhere along the way, we lost that, and the result is what you are now experiencing. We have expressed our concern frequently over the years, but it has never made enough of an impact that MT reverted back to the old way. If I remember correctly, we had a MIX request in, also, for all of the good it did.
Ruby Bomboy, RNC Application Specialist Information Services Mount Nittany Medical Center 1800 East Park Avenue State College, PA. 16803 814-231-7119 Pager: 814-567-0262 [EMAIL PROTECTED] This email may contain confidential or personal health information (including any attachments) intended for a a specific individual(s) and purpose that is privileged, confidential or otherwise protected from disclosure pursuant to applicable law. Any inappropriate use, distribution, or copying of the message or attachments is strictly prohibited and may subject you to criminal or civil penalty. If you have received this transmission in error, please reply to the sender indicating this error and delete the transmission from your system immediately. ________________________________ From: Homich Barb [mailto:[EMAIL PROTECTED] Sent: Tuesday, August 07, 2007 10:44 AM To: MEDITECH-L@mtusers.com; [EMAIL PROTECTED] Subject: EMR display of edits to documentation Good Morning, We have concerns regarding how edits to documentation display in the EMR and were wondering if other sites share our concerns. Edited clinical documentation appears in the EMR in a somewhat misleading manner. In the paper world, when clinical data was edited, the user would cross out the incorrect data and initial the change. A new entry would be entered with the current date and time and the entry would state what the edit contained. Currently in the EMR when a change is made to the data, the new data replaces the old data in the assessment and retains the data and time of the original document. There is no indication that a change has been made within the EMR. So clinicians, who are referencing the EMR and have made certain clinical decisions based upon the information found there, may find it hard to substantiate those decisions if the data has changed. The system also allows a clinician to edit the documentation previously entered by another clinician. This edit is attributed to the original documenter, without a reference to the second documenter. The audit trails do give the detail of the changes but the audits are within the individual modules, with more than one module it is difficult to determine the entry point to search out the edits made. We would like to see the EMR give a true picture of the documentation and changes made to the documentation and would like to know if you have addressed issues similar with Meditech. Thank you, Barb Homich Clinical Apps. Manager Berkshire Health Systems ________________________________ BHS CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please notify Berkshire Health Systems immediately by e-mail at [EMAIL PROTECTED] and destroy all copies of this communication and any attachments. ------------------------------------------------------------------------ - This message was secured by ZixCorp <http://www.zixcorp.com> (R).
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