Audit Trails and Medical Malpractice Claims

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As more healthcare practitioners use electronic medical records, the benefits become more evident. These electronic records save time and money by reducing staff time in deciphering illegible notes, tracking related medical records, and improving the quality of patient care. Such records also track the chronology and progress of patient care in what are commonly referred to as audit trails which keep track of each instance a doctor or healthcare practitioner reviewed a chart, ordered a test, and if these operations were performed in a timely fashion. An audit trail is essentially an electronic log book which the patient has a right to access.
Such an audit trail can be very helpful in determining if a patient received the proper care and medical follow-up especially concerning labs, x-rays, and CT scans. They can also help determine if a condition was misdiagnosed or was left undiagnosed.
Audit trails are an important check and monitor on a patient’s care and a significant aspect to the transparent delivery of healthcare services. Like a “black box” in the cockpit of an airplane, the audit trail allows others to determine what went wrong if a patient is injured. It also provides healthcare workers with the information necessary to avoid medical errors in the future.

Holly Haines
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