5.5k views
4 votes
What measures are in place to track and investigate changes made to a patient's medical record?

1 Answer

4 votes

Final answer:

Measures to track and investigate changes made to a patient's medical record include audit trails, access controls, and compliance checks.

Step-by-step explanation:

Measures to track and investigate changes to a patient's medical record:

1. Audit Trail: Electronic health record systems have built-in audit trails that track any changes made to a patient's record. This includes the date and time of the change, the user who made the change, and the specific details of the change.

2. Access Controls: Access to patient records should be restricted to authorized individuals only. User authentication methods, such as unique usernames and passwords, can help ensure that only authorized personnel can make changes to a patient's record.

3. Compliance Checks: Regular audits and compliance checks can help identify any unauthorized or suspicious changes to patient records. These checks can include comparing the medical record with documentation from other healthcare providers and investigating any discrepancies.

User Miguelangel
by
8.1k points