question- looking for guidance

[Larose93]

I’ve recently discovered that the practice manager and the head nurse (clinical manager) have accessed my notes, under my name.  They do not have my password and it was recently changed prior to this discovery. I am not sure how they did it, possible using a master password or spyware. I have no idea. I discovered this because they closed and locked a note before I did the note (we have a 48 hour policy).

I approached the manager about it and she told me ‘it had to be done.’ I told her this was not legal, to which she had no response. Now I wonder how long they have been accessing my notes under my name. 

Question- who do I report this to? I practice in NC.  The medical board? The nursing board? Who do I report the practice manager to?  What actions should I take, besides finding new employment? Has anyone experienced this? Am I overreacting? 

Thanks for any input. 

[ventana]

careful - one or two missteps might not be worth this, did they just close it, or did they fabricate your note?  If it is just closing it might be so they can bill it and this might be more common then you think for the other providers (ie the doc's or practice owners)

 

 

need to get to the root of the problem and state in NO UNCERTAIN terms that no one but yourself uses your sign on information

I would be using strong passwords and changing weekly and monitoring rather this is a common occurrence....

This might not be a battle you want to fight

 

oh yeah and polish up you CV because you are likely going to need it

 

 

 

once again let the powers that be know that this was done and should never be repeated - I would write a note to them and keep a copy.  As well to the person that did it - make sure that they know to never do it again.  (they might have been doing it under orders from their boss)

If you really want to throw a hand grenade over the fence and run - put out a mass email to the whole company that states your position

 

Be careful, there is likely more to the story then you know and if you bite the hand that feeds you you might go hungry...

 

 

[Hemmingway]

ventana gives good counsel in this case. Right or wrong often doesn't come into play in inter office politics. It is who knows who.....who plays nice according to what the company wants to do etc. In all of these cases you have to weight the risk/benefit and, as a wise man once told me, you can only throw yourself on your sword once.

[Guest UVAPAC]

I agree with the feedback thus far.

What is the harm in locking your note?  Did they fabricate/falsify any information? 

 

I can always "addend" my notes:

 

Addendum 8/9/2018:  Note locked by office staff before note completed on _ _ _ _ _ .  Examination showed XYZ, Impression XYZ. 

Re-Lock note.  

[mgriffiths]

In terms of illegality I believe it boils down to whether anything was charted under your name - and whether it states that you completed the chart or if it was closed by another individual.

We had a NP who was fired and she had many charts that were not completed.  I was part of the team who reviewed those charts for issues and made sure that any labs/procedures that had been ordered had been completed or scheduled.  We did not chart anything or change the NP's charting, but did close them once we finished reviewing.  We did not use her login, but rather we are able to open the patient's chart under our own login and then take over any other open encounters to do as we need - but anything changed would be under our own name.

I hope that made sense, but while this could be frustrating, I'm not sure it equals fraud or illegality.

[BruceBanner]

Get more info. Legally, unless your SP is reviewing your charts, no one else can sign and close your notes. It could be they had to close it to get you out of the chart and put an order in? Get more info. I bet it's not as nefarious as it seems.

[Guest ral]

Metadata.

Systems log who, what, and when anything is accessed, logged, or changed.  Any IT person can pull it up.  Unless someone has your password and does it under your login, anyone who does anything to the chart, even if they simply add a period to the end of a sentence that you wrote, the system will log that they did it.

[rev ronin]

Not to mention, accessing IT systems using someone else's credentials without their permission, especially to access the medical data of a third person, is likely a felony, either hacking, HIPAA, or both.

[Reality Check 2]

Be very very careful.

Is this a corporate practice or a solo owner? 

We had a physician's spouse as a manager once who was actually reading our emails as this person had the "master" IT code to set things up. We tried an experiment one morning early and sent each other some emails while sitting in front of this person's  locked computer. The email ding was distinctive and immediate when we were sending the test emails. This person also wired rooms for sound - I am NOT KIDDING. I got a call from the state AG about this practice for hokey billing practices. Things were not kosher in this place. 

If this one thing is going on - suspect other things. Make sure no signature stamps exist. Make sure your script pads are locked where only you can get them.  Protect all your passwords and change frequently. Look for anomalies in emails, charts, etc. 

You have to get your notes done in 48 hours - it sucks sometimes - but they might be looking for things to ding you on especially if you are savvy to their weird practices and spying maneuvers. 

Does your practice have written policies on chart completion? A formal head of IT? A formal IT policy? If not - be suspicious.

Hope it works out well but keep your eyes and ears open and GET OUT if things are hokey. 

My old crusty 2 cents

[CAdamsPAC]

Being a simple man, I would like to know who , how and why my notes were accessed. When the questions were answered to my satisfaction the boom would be lowered that NO one makes an entry into my notes except me; they may write addendums under their own identity but NEVER mine. Will this PO some folks, probably.I think  POing them is better than be peed on by them. This doesn't need to be angry or hostile but it needs to be understood that you will not accept being discounted and trod upon. The ball is in your court and it's your call on the play.

[Larose93]

Thank you all for your responses. Sorry for the delay in my response.  To clarify a few things-

The note was accessed using my login. No one has been given my password and it is reset often. Inaccurate information was put in the note and the note was locked as if I signed it. This was not the case of the SP locking or adding something to a note  

The manager is basically our IT department. I understand keystrokes etc are recorded, but with mgmt being IT, I have no way to recover this data. This place is known to have cameras and audio recording devices, etc around the office to monitor employees. It is a small solo practice basically run by the manager and nurse.

This is not the first time I have encountered some ‘shady’ practices. In the past, when addressed, it was always met with a plausible answer. I am questioning all of these instances again.  

I am revamping the CV.

Thanks again for any input. 

[CAdamsPAC]

8 hours ago, Larose93 said:

Thank you all for your responses. Sorry for the delay in my response.  To clarify a few things-

The note was accessed using my login. No one has been given my password and it is reset often. Inaccurate information was put in the note and the note was locked as if I signed it. This was not the case of the SP locking or adding something to a note  

The manager is basically our IT department. I understand keystrokes etc are recorded, but with mgmt being IT, I have no way to recover this data. This place is known to have cameras and audio recording devices, etc around the office to monitor employees. It is a small solo practice basically run by the manager and nurse.

This is not the first time I have encountered some ‘shady’ practices. In the past, when addressed, it was always met with a plausible answer. I am questioning all of these instances again.  

I am revamping the CV.

Thanks again for any input. 

Yeah, sounds like a place that I wouldn't be able to tolerate. What prevents these people from "doctoring" your notes to meet their agenda? I'd be gone with a letter to the State AG and Medical Board.

[AbeTheBabe]

In my system anyone can go in and "lock" the note or even make changes to it, doesn't have to be under my name. But, no one (including billing department, my SP, etc.) ever does that. They wait for the note to be finished. If they need it quickly to submit for surgery, they will send me a message asking me to finish it. Are you sure they logged in with your username and did that?

[Reality Check 2]

RUN. RUN NOW. BE GONE. Call the AGs office and file a complaint with the medical board as your SP is allowing this to happen. 

Protect yourself. Keep printed copies of notes locked up or copy and pasted as Word files on a thumb drive. 

Time to go....