BACKGROUND: Minimal information exists concerning the use and liability of electronic medical record (EMR) metadata. STUDY DESIGN: We performed a retrospective review of Vista Imaging (VI) metadata concerning when and which images residents and medical students on a surgery service actually visualized; and the laws governing e-discovery were reviewed. RESULTS: During a 5-month period, PGY III surgery residents logged in to VI 191+/-18.3 times; PGY II surgery residents logged in 164+/-34.3 times; and PGY I surgery residents logged in 92.0+/-14.8 times. Family practice residents logged in 21.0+/-4.6 times, and medical students logged in 32.0+/-5.7 times (p < 0.01). Surgery residents logged about once a day (1.0+/-0.06 log-ins/day); family practice residents (0.2+/-0.2 log-ins/day) and medical students (0.3+/-0.1 log-ins/day) logged about only once a week. CT scans were the most frequently viewed image: surgery residents viewed CT scans during 81.9+/-14.9% of Vista Imaging sessions to view 69.3+/-36.5 images (range 1 to 863 images); family practice residents viewed CT scans during 58.0+/-43.8% of Vista Imaging sessions to view 19.3+/-22.8 images (range 1 to 112 images); and medical students viewed CT scans during 89.8+/-30.3% of Vista Imaging sessions to view 24.4+/-6.3 images (range 1 to 95 images). Changes in the Federal Rules of Civil Procedure and the need to authenticate electronic medical records will mean more metadata will be discovered during litigation. CONCLUSIONS: Electronic medical records metadata allow for creation of detailed physician profiles and will likely be used increasingly to discredit physicians during medical malpractice litigation.
BACKGROUND: Minimal information exists concerning the use and liability of electronic medical record (EMR) metadata. STUDY DESIGN: We performed a retrospective review of Vista Imaging (VI) metadata concerning when and which images residents and medical students on a surgery service actually visualized; and the laws governing e-discovery were reviewed. RESULTS: During a 5-month period, PGY III surgery residents logged in to VI 191+/-18.3 times; PGY II surgery residents logged in 164+/-34.3 times; and PGY I surgery residents logged in 92.0+/-14.8 times. Family practice residents logged in 21.0+/-4.6 times, and medical students logged in 32.0+/-5.7 times (p < 0.01). Surgery residents logged about once a day (1.0+/-0.06 log-ins/day); family practice residents (0.2+/-0.2 log-ins/day) and medical students (0.3+/-0.1 log-ins/day) logged about only once a week. CT scans were the most frequently viewed image: surgery residents viewed CT scans during 81.9+/-14.9% of Vista Imaging sessions to view 69.3+/-36.5 images (range 1 to 863 images); family practice residents viewed CT scans during 58.0+/-43.8% of Vista Imaging sessions to view 19.3+/-22.8 images (range 1 to 112 images); and medical students viewed CT scans during 89.8+/-30.3% of Vista Imaging sessions to view 24.4+/-6.3 images (range 1 to 95 images). Changes in the Federal Rules of Civil Procedure and the need to authenticate electronic medical records will mean more metadata will be discovered during litigation. CONCLUSIONS: Electronic medical records metadata allow for creation of detailed physician profiles and will likely be used increasingly to discredit physicians during medical malpractice litigation.