Cut and Paste

December 10, 2013:                                           Bulletin 2013 No. 5

 

Robert Lowes in a Medscape article reports that the Centers for Medicare & Medicaid Services (CMS) is going to regulate the “controversial copy-and-paste” capability of electronic health record (EHR) systems in its campaign against billing fraud.

CMS made a response to a report released online by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). In a survey of 864 hospitals, the OIG found that only one fourth of the hospitals had policies governing the use of EHR copy-and-paste functions. And only 44% had EHR audit logs that record the method of data entry, whether it is copy-and paste, voice recognition, or keyboarding.

The OIG acknowledged that the “ability to ‘clone’ chart notes from a previous patient encounter to help document the next one can help physicians work more efficiently, but also claims cutting and pasting invites fraud, especially if no one edits the cloned information to make sure it's accurate and up to date. Government officials are worried that many physicians bill for higher levels of evaluation and management (E/M) services than warranted by cloning dense blocks of old patient information. For example, a physician may bring forward a diagnosis from an earlier visit — an infection, for example — that no longer applies.”

In its response to the OIG report, CMS said it will develop guidelines to ensure that copy-and paste ‘is used appropriately.’ CMS noted that it intends to work with the Office of the National Coordinator for Health Information Technology (ONC) to develop ‘a comprehensive plan to detect and reduce fraud in EHRs’

HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder have warned the American Hospital Association, 3 other hospital groups, and the Association of American Medical Colleges in a letter last year that healthcare providers who commit billing fraud with EHRs will be prosecuted. In addition, a number of insurance companies that process Medicare claims on behalf of CMS have said that they will reject physician claims if they are based on cloned medical documentation.  Of course HHS does not appear to have taken into account the fact that many hospitals may have a hard time controlling the use of copy-and-paste. Roughly half of the hospitals surveyed said that they are unable to disable, restrict, or otherwise customize the copy-and-paste function of their EHR systems. EHR vendors interviewed by OIG said the same thing.

One wonders if Microsoft has anything to say about regulating cut and paste functions.

 

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