Knowledge Base Article

Many things have changed in the last century, but none more than the ways we communicate. This newsletter for example – it comes to you conveniently through email and the internet. You didn’t have to go out to a newsstand and buy it, you didn’t have to wait on a postal delivery, and you don’t have to worry about misplacing it among the clutter on your desk – it is still there on the internet for reference today, tomorrow, or months later. Personal communication is revolutionary also – my younger grandchildren couldn’t imagine not being able to FaceTime their parents or grandparents whenever they have news to share; my older granddaughter is in constant (and I mean constant!) communication with her friends. We still communicate through the written word, but more often than not, this is accomplished electronically with assistance on everything from grammar to content. This audience certainly appreciates the joys and heartaches of the templates and canned text of electronic medical records. The changing world of communication and documentation requires frequent updates to the rules to keep up with new innovations and practices.

Medicare recently addressed two issues related to communication and offered a little relief while maintaining control on certain aspects. A good idea, since a plan without checks would allow common sense and risks to be ignored - trumped by convenience.

The first issue relates to communication via texting in a medical environment. CMS recognized that texting has become an essential and valuable means of communication among healthcare team members, but wants to ensure providers “utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations.” In a memo to State Survey Directors on December 28, 2017, CMS now allows texting of patient information (protected health information - PHI) among members of the healthcare team through a secure platform. They drew the line however, concerning patient orders – texting of patient orders is prohibited regardless of the platform utilized. The preferred method for entering orders is through a computerized provider order entry (CPOE). Practitioners can still hand write orders into a medical record, but the CPOE has the advantages of an immediate download into the provider’s electronic health records (EHR), automatically dated, timed, and authenticated. To minimize the potential risks associated with the texting of PHI, CMS expects “providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized.”

The second issue addressed by Medicare is documentation by medical students. MLN Matters Article MM10412 explains the new rule that allows teaching physicians to verify in the medical record any student documentation of components of evaluation and management (E/M) services, rather than re-documenting the work. This will be a huge timesaver for teaching physicians and is not likely to have any effect on the quality of the medical record. Like with the texting rule change above, there are some limitations to this rule change:

• The teaching physician must verify in the medical record all student documentation or findings, including history, physical exam and/or medical decision making;
• The teaching physician must personally perform (or re-perform) the physical exam;
• The teaching physician must personally perform (or re-perform) medical decision-making activities of the E/M service being billed; but
• The teaching physician can verify student documentation of the physical exam and medical decision-making rather than re-documenting.

Both of the above rule changes provide a little relief to healthcare providers that hopefully will result in time savings and better communication while still protecting patient privacy and accurate medical records.