How might metadata be used to investigate fraud?
Read the Practice Side Case Study: Metadata can be “big brother” then answer the questions below.
Complete your work on a Word document then copy and paste your responses into the correct area in the assignment submission link.
Case Study:
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..
Questions:
- Given the above case study, how else might metadata be used to evaluate physician, nurse, or other clinician behavior?
- How might metadata be used to investigate fraud?
- How might metadata be used in malpractice litigation?
