. "Appendix B: Legal Aspects of Computer-Based Patient Records and Record Systems." The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition. Washington, DC: The National Academies Press, 1997.
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In addition to its potential for hindering patient care, which may result in negligence liability, excessive patient record system downtime may also create regulatory violations or JCAHO accreditation deficiencies. The following precautions can help protect against inaccessibility of computer-based patient records:
properly maintaining hardware and thoroughly debugging and maintaining system software;
ascertaining other users' experience with system downtime and their ability to bring a system back up quickly prior to contracting for purchase or lease of a system;
including performance standards in any lease or contract with a vendor, as well as guarantees of reliability and of ongoing maintenance support;
taking adequate precautions against sabotage of the system; and
having adequate backup and emergency capability.
Questions of Durability
Medical records must be durable for a number of reasons: to meet state licensure requirements, to comply with Medicare rules, to preserve a record of patient encounters for use as evidence in malpractice and other lawsuits, to permit future treatment of the patient or future notification to patients who have received treatment that creates health risks for them or their descendants, and, in some cases, to support research. Some states require hospitals to retain medical records for 25 years.54 A researcher or research institution may need to preserve medical records for as long as 75 years.
Changes in technology that cause patient record systems to become obsolete before the need for records stored on the systems has ended can mean that old and new systems do not interface. Another potential risk is that unproven new technology may lack durability. For example, the long-term durability of optical disks has not yet been proven.
Copying patient records from an old system to a new system raises special concerns. Reliable evidence of the chain of copying must be preserved so that the copied records can be admitted as evidence in court. The provider must also ensure that copied records comply with a state's hospital and other institutional licensure requirements as to the media in which patient records can be retained.
Conn. Public Health Code §19-13-D3(e)(6); Nev. Operational Rules and Regulations for Health Facilities §449.379-2 (1988); Lic. Rules for General Hospitals in N. Dakota §33-07-01-16.3 (1990).