MEDRECS: Mass Tort Litigation Update

In light of the recent government shutdown and partial lapse in funding for the CDC and FDA, we thought it beneficial to post a reminder about ongoing health alerts as well as  mass litigation proceedings we track.  As a premier medical record retrieval provider, MEDRECS routinely monitors food safety announcements and other warnings published by the CDC.  We often find ourselves gathering records for parties both pre-litigation and during litigation.  

One current outbreak being monitored is cyclosporiasis, a parasite that causes intestinal infections.  Public health officials allege that this parasite can be traced back to a salad mix produced by Taylor Farms de Mexico and resold in restaurants throughout the southern United States, Iowa and Nebraska.  There have been over 600 cases reported in 25 states, resulting in 45 hospitalizations.  Fortunately, no deaths have been reported.  The widespread nature of the outbreak suggests that not all cases of the parasite are related to each other or can be traced to a common source.  An investigation is ongoing.  Despite this outbreak, the CDC encourages everyone to continue eating vegetables and leafy greens as part of a healthy and balanced diet.  

At MEDRECS, we also monitor mass tort litigation proceedings.  SSRI litigation (Selective Serotonin Reuptake Inhibitors), connecting SSRIs to birth defects, has been ongoing for several years now.  In 2010, GlaxoSmithKline, maker of the SSRI Paxil, agreed to settle over 800 lawsuits for over $1 billion.  Now, SSRI litigation appears to be heating up again.  Over the summer a new lawsuit appeared in Pennsylvania alleging a connection between birth defects and the use of the SSRI Zoloft during pregnancy.  Hundreds of similar federal cases from around the country could join the multi-district litigation which is set in the Eastern District of Pennsylvania.  We will be tracking the development of these cases.

When your law firm, company, or governemnt agency finds itself involved in a mass tort proceeding, you can count on MEDRECS as your medical records partner. Our experience and success on large volume high-profile cases is unmatched and our turnaround time for production of records is industry best.  We have worked for the pharamceautical industry, government, healthcare industry, and for parties to numerous food-bourne illness lawsuits, gathering thousands of medical records under strict deadlines.   

Medical record retrieval is simultaneously one of the most important and most cumbersome and confounding aspects of mass litigation. Coordinating, tracking, and managing the complex job of mass record retrieval on these cases can be quite painstaking indeed.  For this reason, law firms, insurance companies, class-action administrators, and government agencies involved in litigation greatly benefit from the outsourcing of record retrieval.

For any questions about MEDRECS or this article, please email contact@medrecs.com 

Hop on the HIPAA Omnibus

In the world of HIPAA we have a dizzying array of acronyms to keep straight:  HITECH, NPP, PHI, GINA, AFEHCT and on and on… Now, the HIPAA regulators at the U.S. Department of Health and Human Services (HHS) have coined a catchy term for the new HIPAA compliance laws that went into effect this Monday, September 23, 2013:  The HIPAA Omnibus Rule

The HIPAA Omnibus Rule is a more stringent set of standards and regulations which provides stronger privacy rights for patients.  The privacy rights are outlined in a new Notice of Privacy Practices (NPP) document which medical providers must give to new patients as of September 23, 2013.  New patient rights include the following: 

  • Patients now have a right to tell their provider to not share information with their health insurer about treatment paid for out of pocket.  According to practice management consultant Mary Pat Whaley, these private payments are often for psychiatric or mental health treatment, which patients do not want their insurance plans to know about. 
  • Stronger regulations are also in place regarding how patient health information may be used and disclosed for marketing and fundraising purposes.  
  • Privacy regulations now extend to business associates of medical providers, including outsourced billing companies.  As a result, we expect third party billing services to become even more cautious and strict regarding the release of patient information in the weeks and months ahead.  

As all of us in the world of litigation know, obtaining complete medical records is one of the more difficult and pain-staking aspects of working up the case.  We will keep our fingers on the pulse of these developments in the months ahead and we will keep the legal world apprised of any changing requirements regarding authorized access to patient medical and billing records.  

For any questions regarding access to medical records under the new HIPAA Omnibus Rule, please feel free to contact MEDRECS, Inc

In light of these new HIPAA regulations, we suggest that any office or firm that stores or accesses patient medical records provide HIPAA compliance training to staff and personnel on a regular basis.  The laws are constantly being updated and the penalties for HIPAA violations continue to become more serious.  Links to helpful websites are below. 

MEDRECS FAQ Page: http://www.medrecs.com/Home/FAQ

Healthcare-Informatics: http://www.healthcare-informatics.com/news-item/breaking-hhs-releases-hipaa-update

HHS Website: http://www.hhs.gov/ocr/privacy/index.html

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MEDRECS L&I Update

Hello MEDRECS friends!  Springtime litigation is heating up and there is a regular need for record retrieval from the Washington State Department of Labor & Industries.  Please take notice: Washington State L&I has been cracking down lately on their acceptance of patient signed authorizations to comply with the State RCW 51.28.070.  In order to authorize the release of L&I records, the Stipulation or authorization form must specifically indicate it intends “to release Labor and Industries records” or “to release workers’ compensation records.” The Department of L&I has informed us that wording such as “any and all medical records” will compel the release of “medical records” from L&I, but not the entire L&I file.

Electronic Health Records at the “click-of-a-button”? Not so fast…

Electronic health records (EHR) have been hailed as a huge technological breakthrough in Health Information Management sciences.  And while EHR brings many benefits, there is still a long way to go before electronic records are available to us at the “push of a button”.  In fact, the idea that EHR has solved everything for us, and that medical records are now easily available from the Provider, is a common misconception.  Healthcare providers have a lot of work to do before we will begin to see seamless and efficient methods for EHR storage and delivery.

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Last week I met with Erin Ussery, a leader in the Health Information Management industry, to try to get to the bottom of what is going on with electronic health records.  In particular, if electronic records are supposed to be such a huge breakthrough in efficiency and cost-savings, then why is it still so difficult to pry records out of hospitals and why are records still so expensive?  What I learned was quite revealing, and a couple of brief examples illustrate the challenges that healthcare facilities continue to face while they try to “go electronic.”

In the early-to-mid 2000’s the electronic health record industry was “hot”, resulting in a blitz to develop and sell EHR systems as quickly as possible.  The healthcare industry became saturated with EHR possibilities which resulted in different EHR systems being installed within one single hospital.  This inevitably led to incompatibility issues. Take the Swedish Edmonds Campus, for example.  Swedish Medical Center is an advanced healthcare facility but their electronic medical record system will make your head spin.  According to Erin, “the records custodian at Swedish Edmonds has more than 5 different EHR systems to search through in order to find records pursuant to a request.  In addition, the custodian must search the hard copy storage of records maintained off-site by Iron Mountain, as well as entertain the possibility of older records stored on an ancient microfilm system.  Billing records are also stored in two different locations depending upon their history:  billing records created more than 4 years ago will be maintained off-site in paper storage.”  Needless to say, tracking down patient records at this facility is not a quick and easy task.

There is also a recent pattern of conglomeration taking place in the healthcare industry: large hospital systems acquire smaller clinics and bring them under their umbrella.  Take for example, a large healthcare system in Yakima with numerous affiliated clinics: pain clinic, cancer center, rehab center, 2 radiology departments, etc..  Nearly each clinic has a different EHR system and several still have records stored on microfilm.  Moreover, in order for the hospital to produce billing statements, the custodian must navigate through 2 separate systems: the first system reveals the account number associated with the particular date of service (DOS) and the second system is where you must enter the account number to find the bill associated with the DOS.  Sound cumbersome enough?  Well, it gets better:  this same process must be performed for each DOS.  So if the custodian must produce billing statements for 15 dates of service, this same process must be repeated 15 times since there is a different tracking number associated with each DOS visit.  The billing statements must then be converted to PDF (15 PDFs) and the multiple PDFs must be merged and excess/blank pages that result from the conversion must be deleted.

Then there is the common concern of excess pages and/or nearly blank pages found in abundance in many sets of electronic medical records.  This occurrence may turn what would normally be a 50 page chart into a 200 page chart, which not only increases the work involved to produce the chart, but also increases the cost.  Why is this so?  Erin states, “One of the most popular and widely used EHR systems is programmed such that each entry made creates a separate document within the electronic record.  So there may be 100 pages of records with each page containing nothing more than one or two lines of content at the top of the page.  When the record custodian goes to produce this record to the requesting party, each page must be selected, QA’d (“Quality Assured”), and then downloaded separately.  It is not uncommon for a 200 page chart to take one whole day for a person to download and QA.”

Speaking of QA (which is really the most important part of this whole process) we haven’t even mentioned the HIPAA disclosure requirements.  There are 14 requirements for an authorization form to be HIPAA compliant.  Furthermore, the records custodian at the healthcare facility must QA every single page of the electronic record prior to release to ensure cogency between the authorization and the information being released.

What we have found is that the process for releasing electronic records is far more involved than just a “click of a button”.  In fact, who would actually want their healthcare information sent around if the only thing the custodian had to do was “click a button.”  These HIPAA protections and strict QA and review of records are important safeguards for patient privacy.

Despite these bumps in the road and the current labyrinthine nature of EHR systems, EHR is the wave of the future and holds great promise as the industry moves forward and irons out the kinks in the current systems.  According to Erin, electronic records currently take longer to find, prepare, review/QA, and release than paper records.  However, we are already seeing many benefits of the electronic health record revolution:  “E-records are more secure than paper records, and are redundantly backed up on proxy servers at secondary locations in the event of disaster.  E-records can also be securely transferred online much more quickly than snail mail.  And new compatibility systems are being developed that allow for the ease of sharing and access among doctors at various clinics/hospitals.”  And of course, e-records are phasing out the need for paper and are thereby saving trees.  Still, for many people electronic records are difficult to read, navigate, search through, annotate, and so on.  Fortunately, MEDRECS is actively creating solutions for these issues such as OCR/keyword searchable PDFs, organized and hyperlinked index within the records, chronologically sorted records and medical record summaries.  While the advent of EHR has yet to speed up the release of information process on the provider side, there is huge upside potential and room for innovation in the EHR world while we work to make EHR more accessible and actionable for all parties involved.

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MEDRECS Tips for Record Retrieval – VA Hospital / Madigan Army Hospital

The Department of Veteran Affairs and Madigan Army Hospital receive a huge volume of requests for medical records.  Naturally, processing time may be delayed in some cases, and for this reason it is critical to provide as much information as possible at the outset of the request.  Today’s “MEDRECS tip” concerns spouses of servicemen/servicewomen:

If the spouse of a serviceman or servicewoman gets injured, they may be treated at the VA or Madigan Hospital under their spouse’s military insurance. i.e., the husband is in the military, his wife gets injured and taken to Madigan.  When medical records are requested from Madigan under these circumstances, it is important to have the “sponsor”, or servicemember’s social security number in order to obtain the records.  If the records are requested using only the wife’s SSN, for example, Madigan may state that there are no records for this patient, when in fact they do have the records, but the records are filed under the husband’s SSN.

As a service to the legal community, MEDRECS provides periodic medical record retrieval tips and pointers that we believe will help to make everyone’s lives easier.  We understand the pressures of litigation, and that’s why we do everything we can to provide knowledge and expertise that helps law firms streamline the record retrieval process.  To download VA and Madigan authorization forms, please visit our Resources page.

Veterans Affairs medallion - Dakota Sisterhood...

Veterans Affairs medallion

MEDRECS update on fungal meningitis outbreak

MEDRECS is monitoring the recent outbreak of fungal meningitis which has been linked to tainted lots of Methylprednisolone Acetate (PF), an injectable steroid mixed and distributed by the New England Compounding Center in Massachusetts.  It appears that most of the victims received spinal injections of the steroid to treat chronic back pain, and a few victims received injections of the steroid in other joint locations. As of this writing, there are over 370 confirmed cases of fungal meningitis and 29 reported deaths across 19 states (according to the Center for Disease Control), with the largest number of cases being reported in Tennessee, Michigan, Virginia, and Indiana.

This terrible outbreak is not the first of its kind, unfortunately. We are reminded of past outbreaks of disease related to tainted food/medicine, most recently the salmonella outbreak of 2009 linked to contaminated peanut butter produced by the Peanut Corporation of America in its Georgia, Texas, and Virginia plants. That outbreak prompted one of the largest recalls of a food product in US history, sickening more than 700 and killing 9 people across 46 states. 

During the 2009 peanut butter litigation, attorneys across the country were mired in the daunting task of retrieving voluminous sets of medical and billing records within a strict time frame with very limited resources (on average, a paralegal can spend 30 hours retrieving medical and billing records for a single patient). Many of these firms turned to MEDRECS for help retrieving records. “I remember working with one attorney who had so many medical records to retrieve, her paralegal just sent us an Excel spreadsheet and we took it from there,” explains one MEDRECS account representative. Another MEDRECS team member also remembers working on the peanut butter cases: “It was satisfying to me to spend my day working on these cases, then read the latest news at night and think ‘at least I’m doing something to help.’”

Our hearts go out to the victims of this fungal meningitis outbreak. We wish a speedy recovery to those who have fallen ill, and we offer our sincere condolences to the family members who have lost loved ones.

(Infographic courtesy of Buckfire Law.)

UPDATE (November 9, 2012)

The total number of confirmed cases of fungal meningitis tied to this outbreak is now 424 with 31 deaths. Our thoughts are with the victims and their families.

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Medical Record Retrieval – Tips for a Successful Retrieval Effort

Welcome Back to the MEDRECS Blog!  Please consider this a forum for all things Record Retrieval.  Medical Record Retrieval is the core expertise of MEDRECS, Inc. and we want to share our knowledge and experience with you in hopes of improving the record retrieval experience for all parties involved: attorneys, patients, clients, adjusters, and healthcare professionals.  Medical Record Retrieval is difficult enough even with all of the resources, skills, knowledge and support of a company like MEDRECS, but it can prove to be extremely cumbersome and perplexing if you jump into it without equipping yourself with the tools and knowledge necessary for a successful retrieval campaign.

Now enter the birth of the MEDRECS blog: the intent of this blog is to fill a much needed space where information and discussion relating to medical record retrieval can flow.  This means that we would love to hear from all of you!  Please feel free to post comments relating to your strategies and successes in your record retrieval effort.

Let us initiate this new Blog with a few key things to remember when preparing for a record retrieval effort:

1)      Specific Authorization Forms

Not all facilities were created equal – i.e. some accept multiple forms of authorization, while others reject all forms of authorization except their own.  It is always a good idea to check your facility list with MEDRECS up front in order to determine whether any facilities will require their own specific authorizations.  This can save a significant amount of time in the long run!  To see a list of facility specific authorizations please visit http://medrecs.com/Resource/FormsDownload

2)      Reconcile the medical records with the billing records

This will determine if anything crucial is missing from the record set.  This falls under the “record collection best practices” category.  It is a reality in the industry that healthcare Providers do not always release all information in their possession, as is explicitly requested in the authorization.  There are many reasons for this, not least of which is accidental non-disclosure of all information.  The record retrieval service will sometimes notice that key information is missing from a record.  But it is best practice to review the records carefully to ensure that all requested information is contained within.

Hello world!

The MEDRECS Blog is live!

Welcome all to the MEDRECS, Inc. Medical Record Retrieval Blog.  This blog is created to be a one of a kind forum for all things record retrieval.  We invite you to visit this site to read, link, and share with colleagues, post your ideas, issues, projects, and conundrums regarding your record retrieval efforts.  We hope this blog will help decipher some of the complexities and confusion surrounding this topic.  Stay tuned!

Need Records…?  Look no further than www.medrecs.com.