Jean Bishop, J Bishop Consulting
Electronic health records may generate a new set of potential healthcare compliance risks and vulnerabilities. The new risk areas, including, the lack of authentication issues, over-documentation and/or cloning, may have significant ramifications beyond billing and coding. Electronic documentation tools offer exciting features designed to enhance communication for most health record users. The use of the system or specific features without appropriate education, training, infrastructure and monitoring may generate data integrity issues, manufactured documentation, increased risk exposure or even undesirable clinical outcomes. This presentation addresses certain areas of concern and discusses potential approaches for detection, evaluation and corrective action.