Separating Professional and Hospital Records

As Patient Centered Medical Homes and Accountable Care Organizations form, the lines between professional and hospital practice become increasingly murky.

CMS has long required that hospital and professional records be separable, so that in the case of audits or subpoenas, it is clear who recorded what.

Today, the BIDMC ACO continues to expand into the community, adding owned hospitals, affiliated hospitals, owned practices, and affiliated practices.

Our strategy to date has been to use our home-built inpatient and ambulatory systems at the academic medical center, Meditech in the community hospitals, and eClinicalWorks in private ambulatory practices which are part of our ACO.

We share data among these applications via private and public HIE transactions - viewing, pushing, and pulling.   

The challenge with emerging ACOs is that professionals are likely to work in a variety of locations, each of which may have different IT systems and each of which serves as a separate steward of the medical record from a CMS point of view.

Our clinicians are asking the interesting question - can I use a single EHR for all patients I see regardless of the location I see them?  

Our legal experts are studying this question.  

I can imagine several answers

For facilities we own and control, we can tag every note created by every professional with a facility code, enabling us to separate out those records created at given location in the case of audit or subpoena.

For facilities that are affiliated but not owned, clinicians can use their favored EHR, but at the end of the encounter, they must create a paper or digital copy of the record and place it int the hospital record of the location which is the steward of the data from a CMS perspective.

Since it is unlikely that every inpatient and outpatient facility we acquire or affiliate with will have the same HIS and EHR applications, it is not realistic to create one physical shared record across all sites.

Instead, data sharing through the HIE, metadata tagging as to the facility/professional that owns each record, and policies regarding what must be done at each site seems like the logical way to go.

As is often the case with challenging workflow and regulatory issues, I welcome the experience of others.   How have you separated professional and hospital records per CMS regulations, but enabled co-mingling of patient data for care coordination and population health?