Paperless systems could benefit the legal system, say experts

The idea of going paperless is very much the topic du jour for many businesses looking to upgrade their operations – both administrative and otherwise. Now, a group of legal professionals have suggested that doing so could present numerous benefits for those working in the legal system.

Joanna Bromhead, partner at Bond Dickinson, has highlighted the advantages of being able to more easily make tweaks to electronic documents and share them with all necessary parties in any given proceedings.

“The ability [...] to annotate transcripts and documents as the trial progressed was helpful in the preparation of closing submissions,” she said, as reported by the Lawyer. “The judge in particular seemed very keen on its use and did not take any handwritten notes during the six-week trial.

“Our clients and experts found the trial much easier to follow than with traditional paper bundles,” the expert added.

What’s more – and as within any industry – going paperless facilitates mobility and flexibility for employees, who would otherwise need to travel around with a wealth of documents and files.

This benefit was touched upon by Andrew Moran QC, a barrister with Stone Chambers, who explained how he was able to carry one particular case in its entirety around on a laptop – a case for which the hard copies were said to have filled several rooms in the court building.

What’s more, electronic copies make it easier to search documents for particular passages or pieces of information.

John Reynolds, a partner at White & Case, explained how statements and court documents are getting much longer. He claimed that without paperless technology, it would be “impossible” to manage and present this information for trial effectively.

Ironically, it could be argued that it is this explosion of technology that has brought so much more data and information to the fore. However, it would appear that while it may have created a lot more collateral for professionals to deal with – be it in the legal sector or any other for that matter – it also presents the solution.

“Once you’ve used [a paperless system], you never want to do a trial without it,” confirmed Mr Reynolds.

Originally published to www.storetec.net’s page.
David Wilkinson,Sales & Technical Director at SSL

 

To keep or not to keep?

to keep or not to keepWhy have a records management plan?

A written policy or set of procedures for records management plan will incorporate risk, research into legislation related to retention, and a sound understanding of the records you generate while building your case. Written procedures remind you and any other staff about your practice’s records management approach, and will demonstrate that you are acting in good faith consistently, especially regarding the permanent destruction of records.

How to make Records Management policy or procedures?

  • create an inventory of all the paper and electronic records, under your custody and control,
  • assign retention periods to records – retention schedule, detailing all the records you have and when they should be destroyed.
  • keep detailed notes of your research on retention to assist with ongoing retention scheduling.

Ongoing maintenance and storage

Once you have a records management plan in place, it is important to keep up with regular clean-up of files. Dedicate a set amount of time to organizing records for a few minutes each week, or an entire day once a year. Be sure to double check your retention schedule at this time. Do you have anything that should have been destroyed?

Don’t forget the electronic records! They will have the same retention as the paper files.

There are two options for storing files:

  • Onsite storage requires secure, clean, and pest-free physical space in your office.
  • Commercial offsite storage is the second option: it is clean, secure, and offers certified destruction. But there are drawbacks: costs can spiral quickly since most storage services will charge fees for retrieval and delivery which can add up over time.
    Records Management Ltd. offers compliant solution for your closed clients files at no cost to you*. Call 1-800-775-0093 to obtain more information about our E-Archive for Law Firms (adherent to the updated retention Guide from the LSUP)

So the Question is – to keep or not to keep? Relocating Medical Practice

Notes, correspondence and  mails (communications)  - Keep

Pleadings – Put in the firm precedent file or destroy

Client documents – Give to the client

Opposing party documents – Give to the client

Case law List and destroy Assets (estates, family, commercial)  - Give to the client

Liabilities (estates, family, commercial) -  Give to the client

Drafts of agreements (commercial, family)  - Keep as evidence of client instructions along  with the final version

Medical evidence – Give to the client

Wage loss evidence – Give to the client

Research (non-legal information referred to at trials or hearings) – Put in the firm research files

LSUP Practice Management Guidelines

File Closing System

Lawyers should have a client file closing procedure that

  • ensures the title is reviewed before closing
  • provides for the storage of closed client files separate and apart from active client files
  • assigns a new closed client file code to the file
  • provides for the destruction of the closed client file at the appropriate time

When to Close Files

Lawyers should only close files after all matters related to the file have been completed and, in particular, after all undertakings have been satisfied.

Distributing and Disposing of File Contents

Prior to closing the file, lawyers should remove any unnecessary documents from the file.

The lawyer should provide to the client

  • client’s original documents
  • opposing party documents
  • reports, asset and/or liability statements or other documents related to the issues in the matter
  • any other court or legal documents not already provided to the client in the course of the retainer such as pleadings, affidavits, transfers, mortgages or similar documents

The lawyer may consider having the client sign an acknowledgment indicating receipt of the documents.

The lawyer may consider destroying or disposing of any documents that may be obtained from court, land title office or other government registry, provided that the lawyer does not anticipate he or she will require the information for purposes of his or her own defense.

Client files that should be retained and the length of retention will be determined by the particular circumstances taking into account

  • whether other sources are available to obtain information contained in the file such as information stored in Registry Offices or court records
  • a lawyer’s potential liability for errors and omissions
  • any applicable limitation periods

The lawyer should keep in closed client files

  • correspondence including e-mail, memos or notes relating to communications
  • file notes
  • drafts and final version of any agreements as evidence of instructions

The lawyer should consider retaining

  • legal research
  • case law, or a list of case law
  • documents to serve as precedents

The lawyer should assign a closed client file code.

The lawyer should send the closed paper files to a storage location.

Storage

Lawyers should store closed files in secure cabinets or locations

  • separate or apart from active files
  • to protect the files from destruction or damage
  • to maintain client confidentiality
  • filed in an orderly fashion for easy retrieval

If the lawyer stores closed client files in an off-site storage location, the lawyer shall ensure that client confidentiality is protected and maintained.

Retrieval of Closed Files

In the event the file is transferred to the client or other counsel, the lawyer should discuss with the client

  • whether or not the client will be charged for
    • time and effort in preparing the file for transfer
    • additional photocopies of file documents
  • if closed and in storage, retrieval of the file
  • restrictions on file transfer if accounts remain unpaid at the time of transfer

Retrieval of Electronic Files

The lawyer should ensure that closed electronic files are stored or saved in a form or format that will be retrievable in the future.

Destroying Client Files

Lawyers should consider whether the client file should be retained indefinitely or whether it will eventually be destroyed.

If the client file is to be destroyed, the lawyer should determine

  • date the file is to be destroyed taking into consideration
    • any legal or regulatory requirements to maintain certain file contents
    • limitation periods relating to the lawyer’s potential liability for malpractice, or misconduct
  • manner of file destruction to preserve confidentiality

Lawyers shall maintain client confidentiality when client files are destroyed.

Reviewing File Management Systems

Lawyers may consider drafting and maintaining a current office manual setting out the systems and procedures for the lawyer’s practice.

Lawyers may also consider reviewing and, if necessary, updating as required

  • all practice management systems
  • firm checklists, substantive and procedural
  • precedents

Lawyers should consider training for firm personnel in the proper use of office systems and implementation of procedures.

Wrapping up Your Medical Practice

  • There can be many factors behind the decision to shutter a practice. Regardless of the motivation, a physician has to follow certain protocols required by law when closing a practice. In this article we will cover the details involved in one of the most critical of these requirements— retaining and managing the patient record— as well as other crucial aspects such as patient notification and a summar

y of any applicable federal or provincial statutes involved in closing your practice.

Retaining Medical Records after Shuttering a Practice

Neither federal law nor the law of any province has any privacy clause that directly addresses how long records are to be retained after a practice closes. The CMPA does suggest keeping the medical record for 10 years (longer for minor patients). There are general guidelines that suggest how a physician’s office should handle the situation; these involve maintaining a clear, written, in-house protocol covering either the storage or obliteration of patients’ medical records. This protocol should keep the following in mind:

  • A policy covering minimum and maximum timeframes for document retention must be defined by the practice, as required by the Federal Personal Information Protection and Electronic Documents Act.
  • If storage of the record is no longer necessary for legal/business reasons, personal details contained in a file must be destroyed.
  • If a medical record needs to be retained indefinitely, there must be a clear reason or justification.

 

Associations like the CMPA or provincial colleges may provide general principles guiding the storage of medical records, however, a doctor should keep provincial statutes in mind, as well. If the statute does not address the issue, then the physician’s office can rely on CMPA principles. Even though they are not mandated, they provide a useful structure, specifically with regards to legal issues that might come up in the future. A physician can also look to regional medical associations to enhance CMPA guidelines.

Provincial Medical Associations –

No standing policy, for the most part; these entities usually suggest physicians reference provincial college protocols.

CMPA

-10-year storage recommended; original files are encouraged.

Provincial colleges – 10

-year guideline, as well, although some can go as low as 5 years in their recommendations.

Notifying your Patients about Your Practice Closing

In general, provincial entities adhere to a policy of prompt, well-defined notifications to patients when closing a practice. 3 months is a general guideline, but a longer period is encouraged. Types of recommended notifications include in-person notification, written notification by post, or telephone notification.

If the scenario entails the transfer of the practice to another doctor, notifications should introduce the patients to the doctor taking over the practice. When there is no physician is taking over a practice, it is acceptable and recommended to suggest local doctors to patients.

Third-Party Notifications

The physician’s office is required to alert the provincial college that the practice is shuttering; the college will also need to know where the records will be stored.

In the case of a group practice, there may be formal guidelines within the partner agreement. If there is not, it is best to arrange shutting down your practice when it will be convenient for your associates to relocate, or to give them enough time to find a new associate.

Employee Notifications

Labour standards define a minimum period for notification that is based on how many years the employee has been in your employ. If notice is not possible, payment covering what would have been the period of notice is required. Many practices go beyond the minimums as a matter of courtesy. Consulting a labour lawyer can be advisable to ensure that you are doing everything above board and preventing future litigation. You may want to consider keeping some employees on after closing your doors to oversee record transfer, bill reconciliation, and so on.

If you are transferring your practice to another doctor, it is suggested that current contracts still be cancelled and termination notice given. Some provinces require this under law. The new physician can start new contracts with any employee retained, with new start dates for vacation and termination entitlements.

Transferring the Physical Assets of a Practice

Equipment and furniture

There are three values that can be employed in assessing the worth of your practice’s physical assets:

Market Value

- The value assigned an asset by a reputable “assessor”, usually a vendor of comparable equipment.

Book Value –

The value determined by record, usually accounting.

Buyer/Seller-Determined Value

– The value agreed to by both parties.

Remember, if any of the equipment being sold is viewed as a medical device, it must be divested of under the regulations defined by the Food and Drugs Act concerning Medical Devices.

If there are leases involved with any of your physical assets, you can consider transferring the lease to the physician coming into your practice or, alternately, arrange the close of your practice in tandem with your lease’s end date. Remember, there might be fees involved in early terminations of leases.

Drug Disposal or Transfer

When disposing of any drug sample or product, a physician must take the utmost care to adhere to and consider environmental concerns and regulations. No contamination of local ground water should take place. Health products can also be handled by:

  • Transferring them to practice’s new doctor
  • Returning them to drug reps
  • Putting them in the hands of medical waste disposal professionals
  • Giving them to a pharmacy for disposal
  • Consulting local authorities

Making sure that patients retain access to their medical files is critical; continuity of care should be preserved whenever possible. There are some guidelines to keep in mind regarding patient record access or transfer:

  • A patient’s request for a record transfer takes preeminence and should always be heeded.
  • The transfer of any medical files should be done with due diligence and as quickly as possible.
  • When a patient does not place a request for transfer or cannot be found, the doctor’s next recourse must be to try to transfer the record to a nearby physician.
  • Medical files should NEVER be sold.

To protect the physician against future litigation, he or she should always retain an original copy of the record, as recommended by the CMPA.

Professional Storage Facilities

A bonded storage facility is an appropriate alternative when no transfer can be made. If you live within Labrador or Newfoundland, it is acceptable for records to be stored with a relative. Any bonded storage facility should have an agreement drawn up which the physician should sign. This agreement should cover:

  • A detailed description of the responsibilities of the facility
  • Explanation/clarification of the facility’s policy regarding security
  • Explanation/clarification of the facility’s policy regarding  patient privacy
  • A protocol covering destruction of records
  • A protocol covering record access
  • A detailed fee schedule

 

EMR Storage

It does not matter what format you use to store your patient’s medical records— your responsibility remains the same. In the event that your patients’ medical records are retained in a digital format, you should retain a license and/or access to any software involved, or make sure that you have a copy of the data contained in your EMR system.

It is likely that your EMR service will facilitate this process and make sure that you retain a copy of all data even if your license to the necessary software has expired. PDFs are the most user friendly way to retain your EMR data.

Make sure to retain your data in multiple formats, since technology changes so rapidly. For example, you can keep a disc copy, a copy on an external hard drive, and a copy on your local hard drive.

All personal information should be encrypted on EMRs. Encrypting one of your backups can also be a good idea. There are many IT experts that can facilitate this process, if you have any questions.

Having Closed Your Doors

Now that you’ve shut down your practice, you should consider maintaining the phone line associated with the office and setting up a message that lets callers know about the closure. A timeframe of 3 to4 months after closing should suffice. Make sure to include information in the message as to where patients can access their EMRs or files, if need be.

Guidelines to Keep in Mind When Closing Your Practice

Physicians often have a lot of questions about what needs to be done when closing an office/practice. In some cases, there may be particular difficulties involved that demand the physician contact to the CMPA. At other times, a provincial medical college can suffice and provide the appropriate information. Then, of course, there’s always provincial or federal legislation that could provide context or clarity. Whatever the scenario, it is always good to have some general guidelines to the process.

As the digital age brings us into a time of advanced communication and greater mobility, more and more physicians are making the choice to relocate a practice adding to the already myriad “traditional” reasons for closing a practice. Thankfully, the digital age is also providing a lot of new options in dealing with the transition. Below are some guidelines in summary to help you through the closure or transfer of your office and practice.

Alerting Patients, Associates & More

If it is possible to plan notification ahead, there are two things that should be included when notifying.

  • Clearly state the date of the closure/transfer
  • Clarify the process by which the patient can obtain a copy/transfer of the record

Appropriate formats for notification include:

  • a written letter to individual patients
  • a posted notice in a general public space at the practice
  • an announcement in a local publication
  • a voicemail message that will be heard when someone calls into the practice

The Transfer of Records

When patients decide to find another doctor, they will need their medical records transferred to the new practice. It is considered appropriate to charge a service fee for the transfer of medical records, but make sure to check provincial legislation on the matter. The timeframe for the transfer can be between 4 to 8 weeks; anything longer than this is generally considered unprofessional.

Make certain that your office has obtained the correct authorization from your patient before initiating a transfer. Under some scenarios, you might even want to look through the record before transfer. Something to note: a physician’s office should retain the original records, as well as appointment calendars and phone logs. Retaining originals can make a significant difference down the road if a former patient ever initiates a complaint or lawsuit against you. Original records outside your control could be potentially edited, misplaced, or destroyed.

When dealing with record scenarios, make sure that you and your employees keep provincial requirements regarding the retention of records in mind. Even if you maintain digital EMRs, you still need to consider provincial legislation. Whatever your jurisdiction, your law will require that you retain the records responsibly and safely for a certain amount of time. The CMPA considers 10 years a reasonable timeframe for the retention of adult records; for minors, you should retain the record until 10 years after the minor reaches the age of majority.

There are more and more businesses cropping up that can professionally handle EMR or physical record storage. Looking into such options can be very useful, especially when long-term storage is involved.

If you are dissolving a partnership at a group practice, your associates may retain the records; this scenario is naturally more likely if any of your patients are remaining with the practice. You should make sure to have a clearly defined agreement regarding who owns the medical record. It is usually par for the course that the physician who began the record should retain access to it; however, agreements can always help to ensure that no grey areas pop up later on.

PATIENT CARE – Transferring to a New Physician

In some cases, your patients’ care may have been administered under the auspices of a hospital or similar health facility. If that is the case, it is necessary that the medical record contain clear documentation of the patient’s transfer to a new physician.

Setting up follow-up care for those patients who are in the middle of tests is of course critical. It is the moral, professional, and legal duty of a physician to make sure that patients who require follow-up receive it and experience no delay in diagnosis or treatment.

There have been myriad cases of physicians closing their practice and not setting up appropriate follow-up for patients. A good redundancy to put in place to avoid such scenarios is to notify the laboratories, facilities, and referral physicians you work with that you are closing, much as you would your patients and employees. Give them forwarding information and let them know who to get in touch with should a patient fall through the cracks. It is also necessary for a physician to announce their practice’s closure to the body overseeing their medical license and the CMPA.

IN SUMMARY:

When closing a practice, ask yourself:

  • Have I/we done our due diligence in arranging follow ups for patients who are still in limbo?
  • Has timely and clear notice been sent or announced to all appropriate parties?
  • Do patients know how and where they can access their medical record?
  • Have all transfers involved the correct patient authorization?
  • Have long-term arrangements been made for the storage of records?

Understanding Breakthroughs in Medical Record Keeping – OCRs

Keeping track of medical records is a critical factor in any practice. New trends in medical records are surfacing every day, especially around electronic medical records. One buzzword associated with EMRs that has been coming up a lot is Optical Character Recognition, or OCR, a process involved in the scanning and translation of paper records into digital records.

We’ve formed a set of questions & answers around the topic to help doctors considering or already using this technology with any queries they might have.

OCR… What is it exactly?

Optical Character Recognition basically takes handwriting or printed text and converts it into text that is editable or readable to machines. This converted text (which is essentially an image) can be used to fill in fields in an Electronic Medical Record.

Isn’t that just scanning?

A scan is just a digital photograph or photocopy of a hard document. You can’t edit or manipulate the text in a scan the way you can with images created in OCR.

Does the College have any policy covering OCR?

The College does not have any established policy covering OCR, but it does reference scanning. It asserts that original, hard copy records can be shredded once a scan has taken place.

High quality scanning should usually result in a quality reference document with good data, but there is always a chance that a low quality scan could result in an illegible record. Additionally, if technologies and standards evolve with time, a digital record that is relevant today could be irrelevant and therefore illegible in the future.

To ensure a high quality of scanning, the CMPA provides the following guidelines:

  • Hire a service provider that has experience and a strong reputation
  • Make sure that there are protocols in place to ensure a high quality digital record
  • Confirm that the scanning involves QCs (Quality Checks)
  • Create and share a documented list of protocols pertaining to the scanning that all parties involved will have access to
  • Make sure that the data created cannot be altered (e.g.: a read-only PDF)

Is there anything to worry about when it comes to OCR?

As with any endeavor, mistakes can happen— even with machines. Although OCR engines are technologically advanced, their ability to interpret data is not always perfect. It can be affected by the source material: whether it’s a good copy or not, whether it’s handwritten or printed, etc. Sometimes letters or numbers can be “misread”. Obviously this could create a critical situation if two numbers were interpolated in the result of a test, for example.

The legality and relevance of an OCR document can also be questioned. A court of law or the College may not consider it an authentic copy of a record, since it has essentially been interpreted.

Is it safe then to use OCR?

Certainly, as long as QCs take place during the process. Most quality providers will have a person on staff who verifies that the OCR has read the record correctly.

There are exceptions:

  • If a test result is received as a hard copy and not a digital copy, OCR should be avoided. Misread test results can create dangerous complications for a patient. Whenever lab tests are involved, you should retain the original hardcopy and just scan it or manually enter it into a digital system.
  • If OCR is being used as a comprehensive system of record keeping, a scan or the original hard copy should still be kept on file as backup.