May is Mental Health Month

May is Mental Health Month.  According to the National Institute of Health, depressive disorder affects 17.3 million Americans.  There are varying levels of depression, some people require therapy and medication.  Others are able to abate symptoms through behavior modification.   Dealing with the stress of the pandemic has exacerbated depression symptoms for many.  Self-care and positive talk are often helpful in moving forward though the day.  

5 Tips for self-help include: 

Exercise – The reason exercise is helpful to treat depression is that the chemical endorphins are released with activity.  A short brisk walk several times a week may help. 

Avoiding sugar – Eating foods with folic acid and omega -3 fatty acids may ease symptoms.  Add some avocado to your salad for a boost.  

Set objectives daily – Consider things like making your bed, going for a walk or calling a friend in objective setting. 

Be kind to yourself – Positive self-talk can help.  Congratulate yourself on small victories.  For example, compliment yourself on completing a task that you were putting off.  

Mindfulness – Mindfulness is a form of meditation where you quiet your mind to focus on the present.  Take one day at a time.  

If you or a loved one is struggling with mental health reach out to the Crisis Text Line.  Text Hello to 741741.  The line services anyone in any type of crisis. 

How Chronologies Can Assist the Client in Litigation

May 2021 

Chronologies provide an exact and easy to read timeline of medical events. They are an efficient means to parse out relevant data related to a case. When records are voluminous, or a precise and detailed identification of critical events are needed, a chronology may be warranted.  

There are many styles and formats for creating a chronology. Information such as the date, time, place, and provider of care are identified. Further customizable details such bates numbers, an explanation of medical terms/abbreviations, imbedding of pdf medical record pages, and comments regarding standard of care are sometimes included per client preference. Chronologies can be written in a partial verbatim format whereas the nurse utilizes exact words from the chart, or can a summary be written in the nurse’s own words as an interpretation of events. There is no one size fits all chronology. Sometimes a combination of verbatim and pertinent verbatim can be used to produce the most efficient work product.  Pertinent style may be used for events surrounding the alleged injury, while a summary is used for related but noncritical information. Headers within the chronology can be used to identify information such as the source document and author. 

Microsoft Word or Excel can be used as the foundation for a chronology.  The table format is Word is most common.  There is also specialized software to create work products however, given chronologies are sometimes shared, compatibility can be an issue. 

BATES DATE /TIME SOURCE COMMENT 
Pdf 00123 of 000150  Or  JDOE-WAVERLYMED-00010 03/23/2021  0700 Waverly Medical Center / Bill Smith, MD   23 yo presents to ER with cough x3 days & fever 103.2. SOB, unable to complete sentences without cough  SOB = shortness of breath 
Example of a Chron entry

Small, seemingly unrelated events are often a precursor to an injury. Non-medical staff may lack insight and real-world experience needed to understand the relevance to injury and thus, these details are often omitted from the work product. Nurse provided chronologies are a cost-effective way to obtain relevant case data. Through training and education, nurses have in-depth medical knowledge regarding standards of care and the ability to analyze data and link events to breaches in the standard of care, Missing and tampered records as well as gaps in medical care are easily identifiable to a nurse.  

R&G Medical Legal Solution’s nurses provide accurate chronologies and customizable work products. Please call 623-555-3333 today to find out more information about obtaining case related chronologies.  

April is Autism Acceptance Month

Autism is a developmental disability that may impact a person’s social skills, communication and ability to self-regulate.  It typically appears in during early childhood and the level of disability varies from person to person.  According to the Center for Disease Control and Prevention Autism has risen from 1 in 150 in 2000 to 1 in 59 in 2021. 

Since 1972, the Autism Society of America has worked diligently to promote acceptance and educate the general public about Autism.  The Autism Society has formally announced a shift from “Autism Awareness Month” to “Autism Acceptance Month”.  They are calling on the media to promote this change in their coverage in order to promote a higher level of acceptance and opportunities for those with Autism.  This year’s campaign, “Celebrate Differences” is observed throughout April. 

There are many ways to support those with Autism.  The Autism Society offers a free course, Autism 101 which takes about 30 minutes to complete.  https://www.autism-society.org/living-with-autism/how-the-autism-society-can-help/online-courses-and-tutorials/#autism101.  The offering is sure to increase knowledge around the subject matter.  The Ohio Center for Autism and Low Incidences offers free training modules on various Autism topics.  https://autisminternetmodules.org/help.php.  The Autism Society shares stories from family members and individuals on the spectrum.  Stories can be submitted to stories@autism-society.org.  Autism Matters is a free electronic newsletter.  Business can subscribe and post the information in public viewing places.  Joining the Autism Society can be completed online.  A household membership costs only $40.00 annually.  https://www.autism-society.org/get-involved/join/.  The benefits include access to information along with promotions and giveaways. 

Many businesses are now doing their part to promote acceptance.  AMC theaters, Home Depot, Ford, CVS, AMC, Walgreens and Microsoft have developed programs to hire and train those with disabilities to include Autism.  AMC has gone 1 step further and developed a program of monthly movie offerings for those with disabilities.  The lights remain up and the sound is turned down in order to decrease stimulation that many with Autism find bothersome.  Sesame Street at SeaWorld in Orlando provides specialized training for Associates to ensure they understand how to best interact with those with Autism.  They recently introduced Julia, a 4 year old with Autism, as a Sesame Street Character.  Quiet rooms are provided for the people with disabilities who may need a break.

Kit Albrecht author of 5 Guidelines for Autism Acceptance Month and Beyond (https://www.assistiveware.com/blog/5-guidelines-for-autism-acceptance-month) provides helpful suggestions to promote Autism acceptance.  Kit points out not all people with Autism like to be referred to as a person with Autism.  Some prefer no reference to it.  Afterall, people with Autism are people and pointing out the disability may not be necessary.  Living well, not becoming normal is another point made.  Focusing on reducing hypersensitivity, promoting education and employment should be the focus of support. 

In sum, awareness of support services and acceptance of those with Autism should be the focus of Autism Acceptance month.  Celebrating difference and encouraging inclusion for people throughout the year facilitates acceptance for those in need of greater understanding. 

Women’s History Month

Women History Month logo

March is Woman’s History Month, celebrating women and their contributions throughout the history of the United States.    This formal recognition of women came about in 1980 as the result of an initiative by Representative Barbara Mikulski, from the House of Representatives, and Senator Orrin Hatch.  Together they co-sponsored a Congressional Resolution for National Women’s History Week honoring the achievements of American woman.  President Jimmy Carter designated a week, March 2 -8, as National Woman’s History week.  By 1987, 14 states extended the celebration to a month-long period.   Congress followed their lead and officially declared March the month celebration of women.   

The role of woman in the United States has dramatically evolved. Women are leaders of large and small companies and woman serve at the highest levels of government.  Iconic women such as Eleanor Roosevelt and Susan B. Anthony changed society in dramatic ways in terms of being role models for advocacy for people.  Amelia Earhart, was a bestselling author, pilot and was instrumental in pioneering a role for woman in aviation.    

Women of present-day lead some of the largest companies in America.  Mary Barra, CEO, lead General Motors, lead the company efforts to make ventilators during Covid.  Carol Tome, CEO of UPS, lead the company the Covid pandemic.  UPS stoic shares doubled as of October 2020.   

The military is one are that women have excelled.  For example, in 1989, Captain Linda Bray led the 988th Military Police Company and was the first woman to command American troops in combat.  In 2012 Army General Ann Dundwoody became the first woman to reach the rank of 4 star General.   In 2015, Captain Kristen Griest and Lieutenant Shaye Haver were the first women to complete Army Ranger School.  Woman now serve in many previously closed areas of the military.  For example, combat roles such as infantry and certain aviation platform are now open to women.  

Woman have made strides in politics.  In 2005 Condoleezza Rice, became the first black woman to service as U.S. Secretary of State.  In 2019 Nevada became the first state to have woman hold the majority of state legislative seats.  A record number of women are serving in the 117th Congress and we now have a female Vice President.   

The future is bright and encouraging for women.  Opportunity exists in every faucet of the private and public sector.  The information age of the internet and social media provide a platform for growth to include resources, education, training as well as a voice to be heard.   

In the words of Helen Keller Alone we can do so little; together we can do so much”.

What is a DICOM?

DICOM Images

What is DICOM? 

In a clinical environment dealing with any medical imaging, DICOM, short for Digital Imaging and Communications in Medicine, has become essential. The broad application of DICOM is not difficult to understand, given the need and usefulness of medical imaging in healthcare. It allows the storage, viewing, and sharing of medical images and related data on devices within and across medical facilities.  
  

The standard communications protocol used to capture, store, and transmit medical images and related information is DICOM. In medical imaging, DICOM acts as a blueprint for the information structures and procedures in medical imaging systems that control the input and output of data. Both the protocol itself and its corresponding file format are referred to by the term. All data acquired in the medical imaging process is stored in this format. Without it, it would be considerably more difficult to exchange information between various imaging devices.  

Differences between DICOM and PACS, RIS, and CIS 

In addition to DICOM, words such as PACS, RIS, and CIS are often discussed , especially when talking about the benefits that have been brought to healthcare by modern software technologies, standards, and protocols. With regard to what differentiates them, this may lead to some confusion, particularly when it comes to the difference between PACS and DICOM.  

Medical IT systems focused on networks of different devices are the former. DICOM is the common protocol and file format that defines the communication between these devices and allows many different systems to communicate equally.  

Now that that’s clear, here’s an overview of the most popular medical IT systems:  

  • PACS (Picture Archiving and Communication Systems) are medical imaging systems that provide multi-modality storage and access to images. Its key application is as a superior storage option that removes the need to store and retrieve data manually. 
  • RIS (Radiology Information System) – Another type of information system for storing and handling medical imaging data widely used in radiological practices is RIS (Radiology Information System). Radiologists typically use it for, among other purposes, scheduling patients, monitoring and interpreting exams, and billing. 
  • As they are applied to the same area and sometimes used in combination, the distinction between RIS and PACS can be a little vague. These are both systems for enabling the handling of patient information, but while PACS provides storage and a long-term patient data management solution, RIS streamlines procedures and enhances workflow by allowing real-time patient monitoring and providing medical records for patients from one central source.  
  • EHR (Electronic Health Record) – EHRs are digital versions of patients’ paper charts. They are digital archives of the entire medical care history of patients. It encompasses medical pictures. EHRs can work in combination with other medical information systems, much like the previously described patient data systems. They can come with a DICOM production, send, or customer, and can be integrated with PACS or RIS as well. 
  • CIS (Clinical Information System) is an information system that documents, stores and manipulates the clinical information of patients. How does this vary, you might ask, from EHRs? EHRs include a patient’s entire medical history and are therefore much more generalized. CIS manages very precise data, obtained directly from inputs from equipment and medical staff. 

In addition to offering countless advantages, such as enhancing workflow and performance, reducing costs and space requirements, these medical information systems allow practices to concentrate more on patient care efforts. In modern medical services, this has made them indispensable.  

To respond to the diverse demands of medical imaging systems, medical technology is continually evolving and diversifying. New kinds of DICOM-compliant applications are constantly being developed, and cloud-based DICOM image viewers have been one of the most important innovations to emerge from this.  

R&G Medical Legal Solutions, is excited to announce that we have developed our very own proprietary online DICOM viewer that is a part of our database management system and will make this service available in the very near future. This will allow our clients to view any records including radiology, 24-7. Please give us a call at 1-623-566-3333 or email us at marketing@rngmedical.com today for a demonstration.  

R&G Medical Legal Solutions, LLC is a highly regarded litigation support services firm.  R&G is a second-generation company headed by Brian Oldham, a retired, service disabled veteran of The United States Air Force.  

Historical Perspective for a Successful Legal Nurse Consulting Firm

R&G Staff 
January 2021 

R&G Medical Consultants, now R&G Medical Legal Solutions, was founded in February 1992 by Rosie Oldham, BS, RN, LNCC. Her background in nursing administration, risk management and quality improvement were extremely valuable in the startup of the firm. 

R&G’s first cases were personal injury and in December 1992, the firm began working on product liability cases (resulting in completion of over 750 cases). This led to staff expansion and rapid company growth. During this project R&G   implemented total quality management procedures. Peer review of work products led to a successful 100% deficiency free submission of claims. From 1994 to 1996, R&G processed over 450 toxic tort cases (water contamination) for the defendants.  In 1997, R&G began focusing on complex medical malpractice and personal injury cases.  

Fast forward to 2021. Use of and incorporation of technology is the foundation of R&G’s continued success to managing large scale projects.  Incorporation of nurse project directors and non-nurse project managers free clients from the administrative burden of coordinating many logistical areas of mass tort. Record retrieval combined with customizable nurse work products allow for one stop shopping for clients.  

Foundational services such as nurse work products that range from in-depth, pertinent verbatim to summaries of care remain a staple.  Hybrid products, such as a combination of pertinent verbatim of key events, combined with summaries of general that capture events in an efficient, cost effective manner are now offered.    

A new service related to radiology films, will be launched in the near future.  Clients will be able to view, manage, and share radiology data online in lieu of tracking and managing CDs.  Key features of the service include cinematographic (CINE) views, digital measuring tools and panning.  

All services at R&G are customizable to fit the needs of each client.  No project is too big or small.  If interested in R&G services please call Catherine Beasley, MS, BSN, LNCC at 623-566-3333 or email cbeasley@rngmedical.com .   

How Veteran Nurses Help Distinguish R&G

Service Disabled Veteran Owned Small Business

January 2021 

Beth Ann Lumpkin, Lt. Col., USAF, NC (Ret.)

Thousands of registered nurses served as active duty, guard or reserve member in the Army, Air Force and Navy Nurse Corps, even the Public Health Service. Individual service duration varied anywhere between three to twenty years.  

The skills acquired in the military are extremely valuable for the civilian job market. Leading teams, critical thinking, cultural sensitivity, organization, adaptability, attention to detail, varied work hours, and solid work ethic are just a few of the traits Veteran nurses gained while on military duty. These traits make military nurses well suited for legal nurse consulting work.  

Nurses with a military background are highly educated. The structure of the military provided professional military education with each level of rank and nursing specialty. Veteran nurses have a variety of specialties translatable to nurse consulting. For example, specialties include operating room, infection control, quality assurance, midwifery, mental health, aeromedical evacuation, critical care and medical surgical are just a few of the areas for which military nurses have provided care. Military nurses provide care in both the inpatient and outpatient settings, and military nurses are trained in managing acute trauma under battlefield conditions. Military nurses must complete continuing education on an annual basis unlike some requirements from states for civilian nurses.  

R & G is a veteran owned and established business that works with a variety of clients. Highly experience nurse consultants, to include some military nurses, are part of the equation that allows R&G to provide outstanding service.  

Please give us a call today to see how legal nurse consulting at R&G can solve problems for you and/or your firm.  Dial 1-623-566-3333 today.  

Legal Nurse Consultants… Put them into action

A legal nurse consultant (LNC) is a subject matter authority on nursing and healthcare matters much like how an attorney is an expert in legal matters. They are state licensed, detail-oriented healthcare professionals, working on behalf of the litigation team.  

Legal nurse consultants apply their knowledge, education, and clinical training to medical legal cases. Supreme is their ability to interpret medical records. Using their nursing knowledge, LNCs can quickly evaluate medical records and distill them into comprehensive summaries, or chronologies. Their attorney clients can then quickly read, understand, and put them into action. 

The primary role of LNCs involves the identifying, analyzing, and evaluating medical records while providing their professional opinions regarding health issues in medical legal cases. This field of study is composed of evaluating the standards of care, causality, and other medically related issues through the examination of medical records, healthcare literature, and legal documents. Their expertise extends to multiple topics, including: long-term care, medical malpractice, personal injury, worker’s compensation, and mass-tort litigation.  

Legal nurse consultants will also be able to establish a chronology or summary of medical records, and prepare evidence for trial. Additionally, they act as a liaison between the attorney, the healthcare provider, and medical experts. In brief, legal nurse consultation is a valuable asset to the litigation team. 

R&G Medical Legal Solutions has an extensive team of certified legal nurse consultants, that are available around-the-clock, 24-7, to assist you with anything you need. We are agile, in that we can scale up or scale down the project workload to adapt to your needs as they change. Please give us a call today to see how legal nurse consulting at R&G can solve problems for you, dial 1-623-566-3333 or send us an email: rngrfp@rngmedical.com

Retrieving Medical Records

Medical record stock image

For the most part, retrieval of medical records is a relatively straightforward process.  Armed with the appropriate HIPAA-compliant release of information, retrieving records for clients is often a matter of determining the appropriate custodian’s contact information and submitting the request.

Sometimes, it is not as simple as submitting a request and receiving the records in a timely manner.  Often provider staff members are very busy–sometimes delays or seeming unresponsiveness are merely a natural byproduct of human beings with hectic workloads.  In these cases, we at R&G have found conducting thorough research at the beginning of the process can improve turn-around time by ensuring that the request submitted meets the custodian’s internal requirements and reaches the correct individual at the organization–the individual who can fulfill the request.  Furthermore, building professional relationships with record custodians, and conducting appropriate follow-up on the status of the request often removes barriers caused by failures in communication or human error.

Still, there are times when conventional methods do not appear to work.  When this occurs, it becomes important to understand the rules and regulations which govern the custody of and availability of medical records.  What happens when records do not arrive in a reasonable amount of time?  What is a reasonable amount of time?  What if the provider appears unresponsive to the request?

The specific answers to these questions are found at the state level, and vary from state to state in terms of the specificity which is clearly defined in the statues or codes.  A state-by-state breakdown is beyond the scope of this post, but we can take a look at the State of Arizona as an example:

What is a reasonable amount of time?

In Arizona, many of the rules pertaining to medical records may be found in the Arizona Revised Statutes, under Title 12, in Chapter 14, Article 7.1, the section on Medical Records.  Although this code provides answers such as whether a custodian may charge a fee to third parties (yes, a reasonable charge is permitted), and the period after the last visit during which the custodian must maintain the patient’s record (six years), it does not define how long the custodian may take to produce the records.  Arizona Statute does, however, touch on this subject in Title 32, which governs Professions and Occupations.  In Article 1   In Article 1, “unprofessional conduct” is defined to include “Failing to make patient medical records in the physician’s possession promptly available…”.   Still, though, one must determine the meaning of “promptly” in this instance.

For further clarification, one might visit the Official Website of the Arizona Medical Board.  In the FAQ there, the board attempts to answer this question for its members, stating that “Three weeks is a reasonable amount of time unless there are extenuating circumstances.”

Keep in mind that this three week period is not part of the statute;  however, knowing that this is the time frame suggested by the Arizona Medical Board may be helpful when communicating with record custodians.  If the response to the request has been delayed, mentioning this interpretation by the Arizona Medical Board may help avoid the necessity for a costly subpoena.

 

No Legal Advice Intended:  This article is for informational purposes only, and is not intended, and should not be taken, as legal advice.  Contact an attorney for advice on specific legal issues.

Sources:

http://www.azleg.gov/ArizonaRevisedStatutes.asp

https://www.azmd.gov/FAQ/MedRecsPhysician.aspx

R&G Certified as Veteran-Owned Business

After completing a comprehensive vetting process conducted by the Center for Verification and Evaluation at the Department of Veterans Affairs, R&G is pleased to announce its certification as a Veteran-Owned Small Business.

Receipt of this designation enhances R&G’s ability to secure government contracts.  In addition, companies seeking to support Veterans through use of services provided by Veteran-owned businesses may be assured that R&G meets stringent government standards of Veteran ownership and management.

Veteran-Owned Small Business Certification
Veteran-Owned Small Business Certification