Question

Metadata can be “big brother” As EHRs become commonplace, metadata can play a role in measuring the quantity and quality of provider clinical practices. This case examines how EHR metadata was used to profile the work habits of physicians in training, in particular, examining if the physicians in surgical training looked at patient radiographic images prior to presenting the patient to the attending surgeon or if they relied on radiologist reports of the images. All physicians in training were expected to review the actual images which were stored in the EHR system. To determine if the physicians in training looked at the images, the metadata in the electronic health information system was examined. To access the EHR images, a physician must input her or his unique identifier and passcode. When the physician accesses or disconnects from the system, the times are automatically and permanently recorded as time metadata under the physician’s unique identifier. Likewise when a physician reviews a specific patient’s radiology image, the system automatically records the patient’s unique identifier and which images were reviewed by the physician in the physician’s unique identifier file. Essentially, a complete audit trail of the physician’s activities are recorded by the metadata. To determine whether or not physicians looked at radiographic images and not just radiographic reports, a 5-month period of metadata was reviewed for each physician. Provider-specific reports were generated by submitting a query to the EHR system. The reports provided information about what images were reviewed, when they were reviewed, how often they were reviewed, how many images were reviewed per session, and which physician reviewed them. With this information, the viewing habits of the physicians could be determined. This case demonstrates that using metadata can replace time-and-motion studies and other methods of evaluating physician and employee behavior..

Discussion Questions

1. Given the above case study, how else might metadata be used to evaluate physician, nurse, or other clinician behavior?

2. How might metadata be used to investigate fraud?

3. How might metadata be used in malpractice litigation?

Answer 1

Q. No. 1. Answer :

Meta data be used to evaluate physician, nurse or other clinician behavior :

* meta data is used to retrieve the patient information to evaluate the physician behavior.

* it is used to measures the productivity of the physicians by knowing quality and quantity of work.

* by knowing the habits of the physicans we can evaluate the behavior of clinicians and physicians.

* by doing audit analysis we can estimate.

* we can determine the weather the physicians worked or not so that we can evaluate clinicians behavior.

* through the physicians unique identifier record should be done all the work and time of the physicians .

Q. No. 2. Answer :

Metadata is having some technical properties, through this it can store the what ever the works done and what ever the information has to need, in the form of files, size, creation date and time, type of compression.

So that when we need to see that information by using unique identification number open the files and these are used to investigate the any frauds by seeing all time and date and work.

Q. No 3. Answer :

Metadata is created by audit control system, these systems can show the use of metadata information, through electronically transferring the information from one system to another, the metadata used in malpractice litigation.