Key Document Management System Features


The paperless office is here to stay, with many businesses, large and small, making the move to online storage. Document management systems come in various forms. Some are simple online filing systems, others are complex with features such as access control, audit trails, encryption, and data backup. The type of information a business maintains is a driver for the type of security needed as a safeguard. For example, law firms often need a system associated with case files that safeguard client personal health care information. A small business many need a billing document management system.  

A robust document management system should offer multiple layers of protection. For example, access controls allow individuals permission to access data. Two examples are personal identification numbers and passwords. Some passwords are specialized and require special characters. The more complex the password, the less likely a hack will occur. Audit trails are another means of protection which provide a history of who viewed certain data and when. It allows for the tracking of a source of a breach. Lastly, encryption provides a way to share files securely as well as limits the viewing of certain documents.  

A good document management system also has a data backup feature. This occurs when data is replicated to an additional system such as the cloud. Theft, data loss, or a natural disaster are just a few reasons to incorporate redundancy into the system as data redundancy is essential for speedy and seamless recovery. If there is no built-in redundancy, the opportunity for recovery of files may be forever lost. The key to redundancy is to balance the redundancy so that data remains as clean and up to date as possible.  

Document collaboration is a more sophisticated feature of an online system. This feature allows for mark up, versioning, searchability, e-signature and customized security. While overkill for some businesses, the features are essential for others.  

Customer support is essential for any document management system. A standard method for contacting the developer should be known and responses should come quickly when there are questions. A client portal with a help button is a common feature for many systems.  

R&G offers clients a Legal Case Tracking System as a secure means of online case storage information. The Legal Case Management System (LCMS) is an integral part of workflow management at R&G. LCMS is a state-of-the-art database providing anytime-anywhere access to case details, retrieved medical records, and completed work products. 

There are no additional fees associated with access. All of R&G’s medical legal consulting or document management clients can: 

  • Track case deadlines and status of records in real time 
  • Access medical records and completed work products 
  • Data is safe and private! LCMS uses BOTH redundant storage (to protect your data in real-time) AND frequent backups (to protect data in case of disaster) 

If you need assistance with a case, please call R&G Medical Legal Solutions at 1-888-486-2245. 

Medical Abbreviations

The use of medical abbreviations has been used since the development of medicine and is a longstanding practice. They are thought to save time and space when writing medical records. Additionally, they are cost effective and can be customized. While many healthcare facilities have gone to electronic records, the practice of handwritten records still exists, thus the continuance of handwritten medical abbreviations.  

Paper records are prone to errors. Illegible writing causes confusion and at times, a delay in care due to a need for follow up with the author for clarification; especially when it comes to medication orders and dispensing. Many abbreviations may have more than one meaning and the staff interpreting the record may not be familiar with the abbreviation being used.  

In 2005 The Joint Commission, an enterprise that accredits and certifies healthcare organizations, adopted a list that is forbidden to be used by Joint Commission accredited facilities. Below is the list along with an explanation of the potential problem.  

U, u Mistaken for “0” (zero), the number “4” (four) or cc Write “unit” 
IU (international unit) Mistaken for IV (intravenous) or the number ten (10) Write “International Unit” 
Q.D., QD, q.d., qd (daily)   Mistaken for each other  Write ‘daily” 
Q.O. D., QOD, q.o.d., qod Period after the Q mistaken for “I” and the “O” mistaken for “I” Write “every other day” 
Trailing zero (X.o mg) (Applies to medication orders) Decimal point is missed  Write X mg Write 0.X mg 
MS     MSO4 and MgSo4 Can mean Morphine Sulfate or Magnesium Sulfate   Confused for one another  Write “morphine sulfate” Write “magnesium sulfate” 

 2020 The Joint Commission Fact Sheet 

*List does not apply to preprogrammed health information technology systems.  

The Joint Commission has made a recommendation to not sure the symbols for “greater than” or “less than” as they may be interpreted for the letter L or the number 7. The symbol for at (@) is discouraged because it may be misinterpreted as the number 2. Instead, providers should write out the words, “greater than”, “less than” or “at” as they appropriately apply in the chart.  

Misinterpretation of abbreviations may result in patient harm to include death. R&G nurses are skilled at reading handwritten records and recognized when a contributing error has occurred. If you are an attorney and need help with your case, please contact R&G at 1-888-486-2245. 

Ethics Training Resource for Attorneys

Ethics word art

Ethics provides the foundation for acceptable standards of conduct and behavior.  It is a framework for determining right from wrong.  Given the nature of the sensitivity legal work, it is imperative for attorneys to be able to identify and avoid conflicts. 

Ethics training has been shown to have a positive impact. According to an April 2019 paper by Frank Fagen, EDHEC Business School, an increase of one hour of ethics training reduces the number of attorney ethical misconduct by 10.506%.

Completing training is now easier than ever due to the online environment and training is now readily offered in an asynchronous fashion.  Face to face offerings, outside of Zoom types of meetings, have all but ceased but should soon resume to some degree as Covid restrictions have eased.  

Pricing is always a consideration. Some ethics offerings are free, while some are available for a small fee.  Some websites offer education for “free” however, there are charges to belong to the site.  

Finding online education can be cumbersome. Subscriptions to sites that offer a catalog of opportunities are often an efficient way to obtain ethics training as well as a plethora alternative subject matter.

Knowing state ethics requirements for CLEs can influence a subscription membership.  The Mario Legal Academy has a synopsis of state-by-state requirements.  Lorman also lists state by state requirements.

Multiple competing priorities provide challenges in obtaining training. Below are 3 sites for consideration to fulfil requirements. Non attorney legal support staff may also find these resources helpful.  

Lawline:  Getting your CLEs through Lawline is easy but you must be a member.  As of 22 June 2021, $199 buys a 1-year unlimited CLE opportunity. Ethical Challenges Facing Attorneys Today is rated at 4.9 out of 5 stars.

Practicing Law Institute: Paralegal and attorney continuing education is available at this site.  An offering on Ethics for Corporate Lawyers is now available.

2Civility: This is a site that lists other free CLEs.  The Buck Stops Here: Ethics and Professionalism for In-House Counsel is featured as a free offering.

LawShelf:  This site has a beginner level course titled Basics of Legal Ethics. It is directed towards attorneys but appropriate for non-attorney support staff.

In sum, there is no shortage of ethics training on the internet for legal professionals. However, knowing state requirements will influence which offerings are a best fit.

Virtual Nurse Associate

Virtual Nurse Associate

What is a virtual nurse associate?  
A virtual associate is an independent contract worker who works remotely in support of clients nationally. Typical tasks include administrative, technical, and business support services. Legal Nurse Consultants are well suited to work in a similar capacity serving law firms who may need assistance on a regular or per diem basis. This allows firms to scale staffing to their immediate needs and “right-size” when/if workflow subsides.  

What does a virtual office assistant do?  
Virtual nurse associates do many things including records analysis, case summaries, chronologies, identifying missing records and/or gaps in care, as well as identifying experts. A virtual nurse can do almost anything an in-house nurse can do. A virtual nurse associate can easily maintain office hours consistent with their clients or work in an asynchronous fashion, whichever benefits the client the most.   

Skills Set of a Virtual Nurse Associate  

Working virtually can be a challenge and is not a good fit for everyone.   Some people find working remotely to be isolating and stressful and prefer to work in an office environment.  Nurses are adaptable and are well suited to virtual work.  Characteristics of most nurses include:  

  • Self-starter 
  • Ability to set and see goals through fruition. 
  • Able to manage multiple competing priorities. 
  • Problem-solving skills.  
  • Excellent oral and written communication skills  

Benefits of Working with a Virtual Nurse Associate  

Communication virtually with a nurse associate need not be a challenge. The nurse can adapt their online hours to match that of the client. Should short notice taskings arise the nurse is available, just as an in-house nurse would be.  

Working with a virtual nurse associate is cost-effective in that they can be used as much or as little as needed. No doubt this model increases profits for firms. For example, the nurse could be used for a working surge before trial. If a client needs to “right-size,” no-layoff will occur as the nurse is an independent contractor without any benefits typical of an employee. The Virtual Nurse Associate does not require other benefits from their clients such as sick time, paid time off, vacation time, health insurance, or retirement benefits.  

A virtual nurse is an excellent fit for a firm who is searching for their “best fit” but needs assistance in the interim. If a less experienced nurse is hired, a virtual nurse could also serve as a mentor to the new nurse. Should the new nurse turn out not to be the best fit, the virtual nurse continues to service the firm seamlessly.  

R&G Medical Legal Solutions, LLC has a virtual nurse program, and no job is too big or too small. R&G nurses have a wide variety of backgrounds to include medical-surgical, emergency department, critical care, and long-term care, just to name a few. This allows firms to take a variety of cases knowing R&G can match the virtual nurse to the background of the case. Please contact Pamela Showers, COO at 623-566-3333 for rates and any questions.  

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.


A Litigation-Oriented Case Database Is Crucial

Tip #2

Look for a Record Retrieval Company Offering a Litigation-Oriented Case Database

The record retrieval company selected should make use of a litigation-oriented case tracking database.  This will save time by allowing instant access to the current work product, which can be posted for secure viewing and downloading by both the legal nurse consulting firm and law firm staff.

In addition to viewing the work product, other vital information can be communicated through an online case tracking database.  For example:  Deadline dates, deposition or trial dates, dates and names of records received, status of the records reviewed, and names of personnel involved in the case can be included.

Having a case database to track the status of the medical records in the review process makes an efficient use of technology and allows the client to assess the status of the case at any time.  It is especially useful when setting deposition dates.  Furthermore, a review of the case status reflects how near completion the case is in terms of the work product, which many attorneys utilize during deposition.  For this reason, the status of record retrieval should be viewable in real time.


Peg Crowell, MS, RN, APRN-BC, LNCC. Originally printed December, 2005
Updated and Edited: January 2016 by Catherine Beasley, MS, BSN, LNCC


American Association of Legal Nurse Consultants (AALNC). (Peterson & Kopishke Eds.) (2010) Legal Nurse Consulting: Principles and Practice. (3rd Ed.). Boca Raton, FL: CRC Press.

Choosing A Record Retrieval Company

Tip #1

Select a Reputable Medical Record Retrieval Company with Electronic Online Tracking

Initial strategic planning for case preparation with record access must include the selection of a reputable, quality-driven record retrieval company.  Attempting this process in-house can be time consuming and cumbersome.

A record retrieval company should not just retrieve the records in a timely manner, it is critical that they provide real time tracking of the status of records. Once obtained, the records should be organized into the proper sequence prior to scanning and Bates numbering.

If outsourced to the right retrieval company, this process can cut costs in case preparation.  In-house staff will be available to support the preparation of cases rather than shuffling through boxes of papers.

The organized records are then scanned, Bates-numbered and uploaded to an electronic on line data base available to clients 24/7.  Electronic records eliminate the costs associated with shipping paper records to various offices and medical Experts.  Access is immediate when time is of the essence.  In today’s mobile world, being able to access and read case records and work products after office hours or while commuting is vital.  The records can also be downloaded and saved to a secure location for off-line viewing.

This service should not require an additional software purchase by the firm.  Ideally the firm can utilize an existing universal electronic platform provided.  Be aware that some retrieval companies charge access, “per click” or archiving fees to law firms so the costs can add up quickly.  Be sure to select a company that provides this access as a value-added service.


Updated and Edited: September 2015 by Catherine Beasley, MS, BSN, LNCC
Peg Crowell, MS, RN, APRN-BC, LNCC. Originally printed December, 2005

Announcing: Litigation Management Series

Law firms involved in product liability cases must be well-versed in legal principles and must also be extremely organized to avoid spending needless time and money in the litigation process.  No matter on what side of the litigation table you sit, preparation is the key to successful resolution.

Complex aggregate torts, such as product liability involving thousands of cases, can quickly become an organizational challenge.  Partnering with the right organization for assistance with aggregate torts is an effective way for firms to increase internal flexibility, leverage resources, and improve cost-effectiveness.

The difficulty arises in selecting the right organization for the job.  In the coming weeks, we will explore popular areas within the legal industry for utilization of external consultants, as well as ground-breaking areas which you may not have considered.  We will provide you with some effective ways to identify internal workloads that can be eased through utilization of external resources, discuss the qualities of organizations that are likely to result in effective partnerships, and share some pointers that will help you avoid some common pitfalls in the process of engaging with external consultants.

Join us next week for the first installment in this series.

Updated and Edited: September 21, 2015 by Catherine Beasley, MS, BSN, LNCC
Peg Crowell, MS, RN, APRN-BC, LNCC. Originally printed December, 2005