NR 510 Assignment The Impact of EHR Fraud Risks and Issues on Nursing
NR 510 Assignment The Impact of EHR Fraud Risks and Issues on Nursing
Since the implementation of electronic records into the healthcare industry, billions of dollars have been spent trying to reduce EHR fraud and unethical documentation practices. The problem is EHR fraud significantly reduces provider revenue and creates issues with best practices and continuum of care standards. Duplicating EHR records is a big issue in nursing because nurses are tired and take short cuts (Balestra, 2017). The financial ramifications of this action are tremendous. Also, EHR fraud is closely tied to patient identity confidentiality issues (Balestra, 2017). The goal of the nursing industry to efficiently and consistently deliver a high standard of care is dependent upon reducing, and eventually eliminating EHR fraud.
Pros and cons on nursing practice:
EHR systems help reduce nurses work load and allow for a seamless sharing of clinical data and patient information (Balestra, 2017). Knowing that EHR fraud has legal and professional ramifications will cause nurses to become more attentive about protecting patient information. Secondly, since nurses are the main healthcare providers who access and update EHR records, these nationally publicized documentation issues will encourage nurses to develop their EHR documentation and informatics skill sets (Lavin et al., 2015). It goes without saying that EHR documentation issues sheds a bad light on the nursing industry (Balestra, 2017). It suggests preventable confidentiality breaches occur on all levels of the nursing industry. Also, continuous copying and pasting issues suggest nurses are either lazy or too overworked to be as detailed as they are expected to be. Copying and pasting has major legal consequences, as vital records that repeat information can be used by attorneys in malpractice cases (Balestra, 2017).
Developing this assignment took a combination of a few key informatics skills. First, I had to use critical thinking, analysis, and problem-solving skills to determine the validity and relevance of the information I researched. My critical thinking skills helped me understand the technical terminology used to describe the legal and ethical issues surrounding improper EHR documentation. I then analyzed relevant statistics and quantitative information regarding cost factors and rate of abuse. I used my problem-solving skills to analyze the effects of EHR fraud in the nursing industry. I used technical/computer skills to gather the information I needed to write the paper. I had to be adept at researching, using a laptop and the Internet, and typing in MS Word. I also had to be comfortable with using email to submit my paper. None of these technical functions were difficult because I am familiar with their processes. I also used project management skills to plan, initiate, and execute writing this paper. Within the body of the paper, I incorporate the data from multiple sources and relate them to the nursing practice.
Recommendations for the future:
According to the OIG report findings (2017), EHR documentation issues will worsen if nurses and other medical personnel who deal with EHR records continue to view EHR records in the same way they view paper records. Nurses must be diligent about not using copy/paste or over-documenting. Medical records contain personal and time sensitive information, for nurses to take their role in protecting and safeguarding this information lightly, shows a lack of integrity (Levinson, 2017). Nurses must change their strategy or times in which they enter patient information into EHR records systems. As long as nurses update information within a 24-hour period, they can find time to accurately update EHR patient records. Overdocumentation also sheds a negative light on the nursing practice because it makes it look as if the provider is “padding” the bill to get more money from the patient or the patient’s insurance company. One recommendation is to use EHR audit log data to review their EHR records (Levinson, 2017). Additionally, the only way to eliminate the issue with copy/paste is to stop. Nurses have a standard of ethical care and confidentiality expectations they took an oath to preserve. Nurses should self-regulate and self-assess even when no one is looking and do the right thing.
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Another recommendation is for nurses who are members of nursing IT organizations to advocate to IT policy makers to create a fail-safe way to alert the system if any fraudulent documentation issues occur. Levinson (2017) wrote in his report that CMS must direct contractors to use audit logs for investigations, and CMS must provide additional guidance and training to providers on how to detect fraud in EHR records. Levinson (2017) also suggests nursing leaders and hospital administrators find strategies to encourage nurses and other staff who access and update EHRs to become partners in the OIG’s goal to lessen the risk of EHR fraud. To date, the OIG report (2017) shows that CMS and nursing organizations have not done enough to track, investigate, and penalize poor documentation practices. Levinson (2017) says CMS can set-up training sessions for nurses and other medical personnel who handle EHR records, which in the long run will cost much less than paying out EHR breach lawsuits and trying to be reimbursed from providers who were paid from submitting fraudulent claims. My personal recommendation is to restrict who can change patient records. For example, if a nurse wants to add or delete information from a patient’s record, the charge nurse must log in and authenticate the change. I also suggest creating a program that does not allow copy/paste. This feature has been added to many websites to guard against students copy/pasting for plagiarism purposes.
There are numerous electronic health record challenges that need to be addressed in order for EHR systems to run more efficiently and to minimize the risk of EHR fraud and abuse. Nurse play a major role in how this process will designed, implemented, and tracked. The accuracy of EHR records is important in nursing because it highlights ethical concerns in the nursing practice. The goal is to help nurses generate more accurate claims while meeting demands to improve patient care. Nursing professionals and leaders can advocate for EHR fraud detection measures and methods on a national level. Nurses can also stay well-informed about EHR regulations and changes, so they will not make the mistake of not adhering to the latest EHR documentation requirements. Providing a high standard of care includes safeguarding patient information and acting in an ethical manner. Confidentiality is a must as EHR records databases are under constant scrutiny for security breaches.
Balestra, M. L. (2017). Electronic health records: Patient care and ethical and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 13(2), 105-111. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2016.09.010
Lavin, M., Harper, E., Barr, N., (April 14, 2015) “Health Information Technology, Patient
Safety, and Professional Nursing Care Documentation in Acute Care Settings” OJIN: The Online Journal of Issues in Nursing Vol. 20 No. 2.
Levinson, D. R. (2017). Medicare paid hundreds of millions in electronic health record
incentive payments that did not comply with federal requirements (A-05-14-00047). Retrieved from Department of Health and Human Services website: https://oig.hhs.gov/oas/reports/region5/51400047.pdf