Electronic signatures save time and money
Electronic signatures save time and money
Agency program gets thumbs up from surveyors
When Home Care of Southern Ohio in Portsmouth decided to jump on the technology bandwagon in 1993 and computerize documentation, administrator Karen L. Marshall, MS, RN, already had it in her head that eventually, her staff would use an electronic signature program. The program she started last spring keeps nurses in the field instead of the office doing paperwork. This not only saves time and money, but means patients get increased and improved care.
Since implementation, she has had the program validated by both Medicare and Joint Commission surveyors, who approved of the policies and procedures Marshall put in place to ensure document security and patient privacy.
Although Marshall didn’t do a prior study on how much time her staff spent in the office going through their mailboxes, printing and signing paperwork, she estimates there is about an hour per clinician saved through the new process.
"If I were starting over again, I would do a pre-implementation study so that I could see exactly what the savings were," she says.
Whenever technology replaces traditional paperwork, there are legal concerns to be addressed. For instance, how would an electronic signature be verified? How are privacy issues addressed?
Marshall dealt with these issues by providing each clinician with a unique identifier that is a combination of the name, operator number, and a clinician-chosen password. Aside from the clinician, only the computer operations specialist has access to these identifiers.
"Even I, the administrator, don’t know them," explains Marshall. The identifier list is kept in a secure, locked site.
Each nurse also signs a Computer Access Confidentiality Agreement. (See sample agreement, p. 30.) Key policies outlined include:
• Nurses will only use their own identifier.
• If the identifier is jeopardized in any way, the computer operations specialist must be notified immediately and a new password chosen.
• If nurses allow anyone else to use their password, corrective action — up to and including dismissal — will be taken.
• A saved note is akin to adding a signature, and the document is locked.
• If a correction or change needs to be made, the clinician must create an addendum.
• The electronic signature consists of the name, patient number, and date at the bottom of the note.
• If you are working in the office on a server, you must log out before walking away from the computer.
No costs, no resistance
Another concern as the century draws to a close is whether the system is year 2000 (Y2K) compliant. However, Marshall made sure all computer systems were Y2K compatible before implementing the system.
"Our clinical system has always been Y2K compliant from development. We also have assurances from our other system vendors that their products are in compliance," says Marshall.
Just in case, there are quarterly tests to determine if the agency can reconstruct electronic records in case of a system crash, and the old standby paper forms are kept on hand.
The agency had already computerized, so there were no hardware or software costs associated with the change. Indeed, the only cost was the one-day inservice to explain the policy, and the time Marshall spent developing some of the forms associated with the program.
Go with the flowchart
Aside from the confidentiality agreement, she created a flowchart of the clinical record order and a grid to explain the disposition of specific forms. (See sample forms, inserted in this issue.)
"We did this to make it clear for us, for staff, and for surveyors whether we print and file a form, print it on demand or make it part of the paper record," she says. "It also tells whether something has to be signed or not, and whether it must be a handwritten signature or an electronic one."
The agency also uses clinical record guidelines that state the purpose, nature, directions, and responsible parties for each form. They were revised to include a statement on whether the form uses a written or electronic signature.
There were no complaints about the electronic signature program from the 200 staff at Home Care of Southern Ohio, says Marshall. "They saw it as a time saver, one and [for] all." (See guidelines, above.)
Medicare and Joint Commission surveyors also thought the idea was a good one. Since the program was implemented in March 1998, the agency has "sailed through" both surveys.
For other agencies considering a switch to electronic signatures, Marshall says it’s vital to have all confidentiality agreements signed before implementation.
"That covers you legally," she explains. You should also make sure your office and medical records personnel are clear on which forms are electronic, which are paper, which need a written signature, and which can have an electronic signature.
Confidentiality yours
Marshall didn’t have a lawyer look at her policy or confidentiality agreement, but she says that other agencies may want to go that route. At the very least, she advises agencies research applicable state laws regarding electronic signatures and be familiar with the Medicare and Joint Commission rules, as well.
"Clinicians should also understand that when the form is saved, that is the final check," she warns. "Within the context of electronic signatures, when the clinician saves the form, they are, in essence, signing the form. Clinicians should not take this lightly."
Source
• Karen L. Marshall, MS, RN, C, Administrator, Home Care of Southern Ohio, 727 Eighth St., Portsmouth, OH, 45662. Telephone: (740) 354-8129.
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