An interesting question has recently come up in terms of ongoing access to an EMR when a physician leaves a practice/retires or when a group medical practice dissolves.
From a shared care perspective, there are well defined benefits in having a electronic medical record system that can be shared amongst multiple physicians in a group practice such as the ability to provide on-call or cross coverage for patients and remote access to the record. However the assumption in all of this is that group practice is the way of the future and EMRs will be a core infrastructure component. BUT, what happens if the group practice dissolves or a physician retires or leaves under good or bad circumstances?
In the paper world, it was much easier to separate out which patients belonged to which physician. These paper records could then be removed from the filing system (or might in fact be stored separately even in a group practice), the physician would take his/her charts and move to a different location. Not so in an EMR based practice. It may not be as clear which patients belong to which physician in this situation. In addition, shared records within group or potentially multi-disciplinary practices make the boundaries of ownership of the physical record less clear.
How does a physician take his or her records and move to a new practice? What are the financial and business implications of doing so? If the EMR is ASP-based (remote server), can the patients be transferred to the new location by changing the rules on who is allowed to access that record? What happens to the original record if other providers have had access to that record and need to retain a local copy or a copy that they can view up to the time that the departing physician has left the practice for medical legal purposes. What happens if the entire practice dissolves and the physicians all go in separate directions. Who takes on responsiblity for transitioning the patient information so that each physician has an accessible copy of their patient's medical records so they can continue to provide care in that new location.
These are the types of issues that challenge the very best laid plans. Physicians are a mobile workforce and over the course of a career it is unusual for a physician to only work at one location and in conjunction with a fixed group of associates. We need to build some flexibility into the processes to ensure that physicians can leave and still appropriately retain copies of medical records or retain access in situations that are appropriate.
If you have experienced a change in your practice that resulted in having to deal with one or more of these issues, please share them by clicking on the 'Comments' link. (If vendors have had experience with this situation, this is a specific instance where vendor feedback is welcomed to ensure that the commentary is balanced)