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ELECTRONIC
MEDICAL RECORDS

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a list of frequently asked questions (FAQs) about
the new rules, particularly addressing which
fields fall under the “non-biographical populated
fields” category. TMB will publish the FAQs on
its website, www.tmb.state.tx.us, in the future,
TMB spokesperson Jarrett Schneider says.

The rules clarify physicians must maintain an
adequate medical record of each patient, “regard-
less of the medium utilized.”

Focusing on Patient Care in order to assume care of the patient at that point. The volume of
Dallas orthopedic surgeon Wynne Snoots, information that’s captured in an electronic medical record is im-
pressive, but much of it is not clinically useful. It was really a burden
MD, whose term on the medical board expired to sort through the volume of information I received to find out
this year, was instrumental in the proposal of the what happened in that two-and-a-half hours in the other ED. And
new EHR rules. Dr. Snoots says the changes were that happens every day.”
a “reactionary measure” to adjust for the way governments, insur-
ance companies, employers, and hospitals are driving the develop- Dr. Schneider says EHRs “give us the ability to make mistakes —
ment of health information technology. new kinds of mistakes that we probably would never have done in
the paper world.”
Dr. Snoots says those entities are more interested in “population
statistics” and the particulars of a patient encounter that pertain to A TMB position statement on EHRs states that the widespread
physician payment than in the information that helps the physician implementation and use of EHRs has compromised the board’s abil-
treat the individual patient. ity “to provide efficient and adequate oversight to the practice of
medicine.” The position statement emphasized that to improve pa-
“What they’re after is the support for the [medical] bill … so the tient care while using EHRs, the necessary data elements in the
physician’s caught in the middle,” Dr. Snoots said. “He has to fill record need to be properly identified, recorded, verified, and tagged.
out a specific set of data elements, page after page of stuff, in order
to get paid. That’s why he looks at the computer when he’s seeing “In recent years, TMB has observed progressive difficulty obtain-
you, instead of being able to listen to you and look at you and touch, ing medical decisionmaking information from current records,
and all the other things important for a meaningful patient-physi- which interferes with the accomplishment of our mission,” the po-
cian relationship. And the computer does not let us use natural lan- sition paper states. “It is not the role of the TMB to endorse EMR
guage or text to provide an outline of what was really done to software or regulate technology. However, it is clearly within the
provide the basis for the decisionmaking. And also on the EMR side, TMB’s scope and oversight duties to set forth standards and expec-
there’s really no emphasis to understand the outcome.” tations for creating and maintaining a useful, meaningful and read-
able medical record.”
The changes to the rules, Dr. Snoots said, are an effort “to be sure
that the content we need to make a decision about the care of a pa- The medical board’s disciplinary rules establish low- and high-
tient is based on fact, not on just guessing.” sanction guidelines for violations of the Medical Practice Act or
TMB rules. A remedial plan for failure to keep proper medical
The data that pile up in a patient’s EHR can create a headache records carries a fine of $500 on the low end, along with continuing
for doctors who are primarily interested in the information that per- medical education (CME) in the “appropriate area,” such as medical
tains directly to a patient’s care. For example, Dr. Murray relayed a recordkeeping. On the high end of the guidelines, an order can in-
story of receiving a recent patient from another emergency depart- clude a $2,000 administrative penalty. For example, in November
ment (ED) after a two-and-a-half-hour stay. 2014, the board issued $2,000 penalties to two physicians. One

“That hospital is on an EMR, and my hospital is on an EMR.
But because those EMRs don’t communicate with each other, the
patient record is printed and sent with the patient when he or she is
transferred,” Dr. Murray said.

“That particular record was 50 pages long. And out of those 50
pages, only two of them had the clinical information that I needed

16 San Antonio Medicine • August 2016