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.  

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.  

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 .   

Trends in Nursing Home Litigation

Nursing home lawsuits have become one of the fastest growing segments of health care litigation. There are nearly 17,000 nursing homes in the United States that currently care for 1.7 million residents, a figure that is expected to quadruple to 6.6 million residents by 2050.(1)  Over 90% of the nursing home residents are over the age of 65, and almost half are over the age of 85; the average age is more than 80.(2)   Issues of concern in care may include: adverse drug events, falls with injury, pressure ulcers, faulty medical equipment, problems with tube feeding, restraint usage, malnutrition, dehydration, residents rights violations, elopement, and abuse and neglect.

Federal definitions of elder abuse, neglect and exploitation appeared for the first time in the 1987 Amendments to the Older Americans Act. These definitions were provided in the law only as guidelines for identifying the problems and not for enforcement purposes. Currently, elder abuse is defined by state laws, and state definitions vary considerably from one jurisdiction to another in terms of what constitutes the abuse, neglect, or exploitation of the elderly. Broadly defined, elder abuse definitions may be categorized as follows: Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. It may include, but is not limited to, such acts of violence as striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, it may also include the inappropriate use of drugs and physical restraints, force-feeding, and physical punishment.

  • Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly or disabled person or with any person incapable of giving consent. It includes, but is not limited to, unwanted touching and all types of sexual assault or battery such as rape, sodomy, coerced nudity, and sexually explicit photography.
  • Emotional or psychological abuse is defined as the infliction of anguish, pain or distress through verbal or nonverbal acts. Emotional/ psychological abuse includes, but is not limited to, verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person as an infant, isolating an elderly person from his family, friends or regular activities, giving an older person the “silent treatment”, and enforced social isolation are examples of emotional/ psychological abuse.
  • Neglect is defined as the refusal or failure to fulfill any part of person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care. Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.
  • Exploitation is defined as misusing the resources of an elderly or disabled person for personal or monetary benefit. This includes taking Social Security or SSI (Supplemental Security Income) checks, abusing a joint checking account, and taking property and other resources.(3)

Estimates of the frequency of elder abuse range from 2% to 10% based on various sampling, survey methods and case definitions.(4) In 2013, state long term care Ombudsman programs nationally investigated 135,620 overall complaints of abuse, gross neglect, and exploitation on behalf of nursing home and board and care residents. Among seven types of abuse categories, physical abuse was the most common type reported.(5)

As the incidence of elder abuse rises, more programs and techniques are being developed by facilities and federal and state organizations to protect our aging population. “Grammy Cams” are being utilized in some states (currently 7 states). This allows families or residents to install surveillance cameras in their room in the nursing care facility. Several states (e.g. California and Maine) are now utilizing Elder Death Review Teams (EDRT) to evaluate nursing home deaths that may be linked to abuse and neglect. Most states now require background checks for all paid caregivers and those with criminal backgrounds are prohibited from caring for elders in nursing homes. Nursing homes and assisted living facilities are providing more orientation and education to their staff on recognizing and reporting signs and symptoms of abuse.

(6) Long term care organizations and associations are pairing with government agencies to promote public awareness of elder abuse and reporting mechanisms. State and federal survey agencies are focusing on abuse in nursing homes and have initiated procedures for timely investigation of complaints of abuse and neglect. Even one incident of abuse is unacceptable and we, as health care providers and litigators have an obligation to protect and defend our elders.

The National Center on Elder Abuse — www.elderabusecenter.org
State Long Term Care Ombudsman Programs — www.ltcombudsman.org
National Committee for the Prevention of Elder Abuse (NCPEA) — www.preventelderabuse.org
National Association of Adult Protective Services Administrators (NAAPSA) — www.naapsa.org
US Department of Justice, Office of Victims of Crime — www.ojp.usdoj.gov
US Administration on Aging — www.aoa.gov
American Society of Adult Abuse Professionals and Survivors — www.ASAAPS.org

References:
1 U. S. House of Representatives, Committee on Government Reform, Minority Office
2 Centers for Medicare and Medicaid Services, Department of Health and Human Services, Health Care Industry Market Update: Nursing Facilities. CMS, 2002:43.
3 National Association of Adult Protective Services Administrators; National Center on Elder Abuse; Elder Abuse Awareness Kit; April 2001, pg. 4.
4 Lachs, Mark S. and Karl Pillemar, Oct. 2004, “Elder Abuse,” The Lancet, Vol. 364: 1192-1263.
5 National Ombudsman Reporting System Data Tables, 2013 – 2014. Washington DC: US Administration on Aging.
6 Long-Term Care Services in the United States: 2013 Overview

Use of Technology Distinguishes R&G

Historical Perspective for a Successful Legal Nurse Consulting Firm

R&G Medical Consultants was founded in February of 1992 by Rosie Oldham, BS, RN, LNCC. Her background in Nursing Administration, Risk Management and Quality Improvement was extremely valuable in the startup of this legal nurse consulting firm.

R&G’s first cases were personal injury and in December of 1992, the firm began working on product liability cases (resulting in completion of over 750 cases). This led to staff expansion and the use of 32 nursing contractors. 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. This successful project required our nurses to input medical information into a statistical data base for our clients. In 1997, R&G began focusing on complex Medical Malpractice and Personal Injury cases. Rosie Oldham,  CEO, also self-published the Medical Legal Internet Directory which contained over 3000 web sites for medical legal research. This directory was published in 2nd and 3rd (on CD) edition by Lawyers and Judges and contains over 5000 web sites. The MLID has been heralded as a great research tool for medical and legal case issues and is sold internationally.

In 1998, one of R&G’s goals was to solidify our position as “the technical leading” legal nurse consulting firm in the United States. At that time, our client base extended across 23 states and into Canada and Israel. The service areas of the firm were expanded to include graphics and illustrations  in our work products that were ultimately used as demonstrative evidence. Merit Screens were streamlined and are now offered for a flat fee. In addition, new software was added to our information systems to track cases, provide conflict checks and expert witness data management. In 1999, we to acquired equipment (laptops/projectors), software, and trained our “technical nurse consultants” adding a new service of technical trial support and settlement consulting services. Utilizing computerized demonstrative evidence, videos and synchronized depositions, we have successfully settled many cases in AZ, NM and NV. The integration of legal nurse consultants providing technical support culminated in our November, 2001, 18 million dollar verdict for a personal injury case in Nevada.

Since January, 2002, R&G began providing services on   large product liability mass tort and has over 140 RNs working on this defense pharmaceutical project. The successful thirteen year growth and expansion for R & G is a direct outcome of our team approach  in 43 states with great attorney clients. The caliber of our staff is educationally beyond the norm (MS, NP, PhD, JD, and MD’s) and directly contributes to our continuing success. Our clients love our “can do” attitude!