The keeping of a central log in the Emergency Department is one of the commitments that a hospital which is subject to Emergency Medical Treatment Active Labor Act requirements must also comply with, found at 42 CFR 489.20(r)(3). This requires a hospital to keep "a central log" on each individual who "comes to the emergency department" as described in 42 CFR 489.25(b), seeking assistance and whether he or she refused treatment, was refused treatment or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged."
The central log must include, directly or by reference, patient logs from other areas of the hospital that may be considered dedicated emergency departments, such as labor and delivery or pediatrics, where a patient might be directed to receive the medical screening exam instead of the main emergency department. Despite the implementation of electronic medical record systems in many hospitals, some hospitals apparently have been told by a surveyor that the central log must be kept in a handwritten format. However, this is neither a federal nor state requirement.
The CMS State Operations Manual provides Interpretive Guidelines for surveyors, revised in 2010. The Interpretive Guidelines for 489.20(r) specifically provide: "Each hospital has the discretion to maintain the log in a form that best meets the needs of the hospital. ...The hospital may also keep its central log in an electronic format."
When designing and implementing an electronic medical record system for the hospital, the hospital should confirm that the system is capable of capturing or generating the information required to be in a central log. If not, the handwritten log should be maintained. If a surveyor has recently given a hospital a deficiency because it kept the log in an electronic format, this should be easily challenged. The hospital should just be sure that its electronic record system can capture the information required to be submitted to the surveyor.
Can include short bio on author here.
Ms. McLaughlin is an attorney at the Austin, Texas, law firm of Davis & Wilkerson, P.C. She graduated with a B.A. summa cum laude from the University of Texas at Austin, and received her J.D. in 1990 from Southern Methodist University School of Law, where she was Order of the Coif and on law review. Ms. McLaughlin practices health law and has extensive experience with a wide range of operational, regulatory, and transactional issues related to hospitals, physicians and other healthcare providers. She also represents healthcare facilities and healthcare providers in licensing and regulatory matters before a variety of state and federal agencies.
The central log must include, directly or by reference, patient logs from other areas of the hospital that may be considered dedicated emergency departments, such as labor and delivery or pediatrics, where a patient might be directed to receive the medical screening exam instead of the main emergency department. Despite the implementation of electronic medical record systems in many hospitals, some hospitals apparently have been told by a surveyor that the central log must be kept in a handwritten format. However, this is neither a federal nor state requirement.
The CMS State Operations Manual provides Interpretive Guidelines for surveyors, revised in 2010. The Interpretive Guidelines for 489.20(r) specifically provide: "Each hospital has the discretion to maintain the log in a form that best meets the needs of the hospital. ...The hospital may also keep its central log in an electronic format."
When designing and implementing an electronic medical record system for the hospital, the hospital should confirm that the system is capable of capturing or generating the information required to be in a central log. If not, the handwritten log should be maintained. If a surveyor has recently given a hospital a deficiency because it kept the log in an electronic format, this should be easily challenged. The hospital should just be sure that its electronic record system can capture the information required to be submitted to the surveyor.
Can include short bio on author here.
Ms. McLaughlin is an attorney at the Austin, Texas, law firm of Davis & Wilkerson, P.C. She graduated with a B.A. summa cum laude from the University of Texas at Austin, and received her J.D. in 1990 from Southern Methodist University School of Law, where she was Order of the Coif and on law review. Ms. McLaughlin practices health law and has extensive experience with a wide range of operational, regulatory, and transactional issues related to hospitals, physicians and other healthcare providers. She also represents healthcare facilities and healthcare providers in licensing and regulatory matters before a variety of state and federal agencies.
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