Key Document Management System Features

R&G LCMS

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. 

R&G LNC Services

Legal Nurse Consultant -AALNC

R&G provides services to firms of all sizes.  Services are performed by US-based registered nurses who possess both clinical nursing experience and specialized legal training. Effective partnerships between R&G and clients are facilitated through the use of Project Managers who ensure timely delivery of work products. 

Though not required, clients and Project Managers use R&G’s proprietary, secure, legal case management system with a built in DICOM viewer, to monitor project progress in real time, with the ability to access finished work products, anytime, anywhere.  All work products are customizable to meet the needs of the clients.

We use US-based Legal Nurse Analysts working in a secure virtual environment. We also offer our clients Virtual Legal Nurse Associates. R&G will match a highly experienced and appropriately specialized LNC to your case.  The nurse can work either on a short term or long term basis.  Client’s have direct access to their assigned nurse in order to facilitate communication.

Give us a call today to discuss your case needs!

Phone: 1-888-486-2245

Email: rngrfp@rngmedical.com

Your Trusted Legal Solutions, On Time, On Target, On Task

Hit by Ransomware? Check out these tools to see if any of them can help you.

Ransomware stock image

If you’ve been hit by ransomware, check out the tools found here to see if any will unlock your files. There are over 121 ransomware decryption tools and it’s growing every day.

Another couple website that we like to check for virus/ransomware removal tools is bleepingcomputer.com and majorgeeks.com

Here’s a recent article covering The No More Ransom website listed above.

“The project, founded by Europol, the National High Tech Crime Unit of the Netherlands’ police, Europol’s European Cybercrime Centre, Kaspersky, and McAfee, launched five years ago and has grown to involve 170 partners across law enforcement, cybersecurity companies, academia, and others. 

The No More Ransom portal now offers 121 free ransomware decryption tools which can decrypt 151 ransomware families. They’ve helped more than six million ransomware victims recover their encrypted files for free – all without the need to give into the demands of cyber extortionists. 

Available in 37 languages, ransomware victims around the world have used the portal to help against ransomware attacks. The website’s ‘Crypto Sheriff‘ allows users to upload encrypted files to help identify which form of ransomware they’ve fallen victim to, then directs them to a free decryption tool if one is available.”  

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.  

Ransomware is getting worse

ransomware stock image

There has been another high-profile ransomware attack and this one could possibly be more significant that the ones before.  

We covered ransomware awhile back, on what it was and how it is a growing threat. You can read that blog here. 

Just last week, Colonial Pipeline, which accounts for 45% of the US East Coast’s fuel, was attacked by ransomware. It took down its systems and forced them to shut down operations.  

https://www.zdnet.com/article/colonial-pipeline-cyberattack-shuts-down-pipeline-that-supplies-45-of-east-coasts-fuel/

Also last week, Scripps Health, a very large hospital network with over 10,000 employees and 7,000 patients, got taken down by a cyberattack.

https://www.10news.com/news/local-news/scripps-health-ceo-addresses-cyberattack-in-an-internal-memo

and

https://healthitsecurity.com/news/scripps-health-ehr-patient-portal-still-down-after-ransomware-attack

both cover that news and the implications they are still dealing with.

In the past year there has been well over $215 million in damages from ransomware attacks around the world.  

With most of the workforce still working from home in 2021, due to the Covid-19 pandemic, its making cyberattacks and ransomware much easier to pull off. Where employees and their PCs were once safely behind the office firewall, are now at makeshift workstations in their home office, bedrooms, or kitchen, using all manner of cobbled-together technologies to get the job done. 

Companies now have a MUCH bigger attack surface. This is due to employees now on all different networks and at various locations. They are no longer working within their organization’s network and covered under its normally secure protection and firewall settings. Some are smart and using a secure VPN connection to stay within their office’s network protection, but most are not. ZDNet has a great article by Danny Palmer on this topic as well.  

If you suspect you or your company has been affected by Ransomware, I am sure your first thought is to shut down or reboot all the computers and server(s) in your office. This is something that you DO NOT want to do. Shutting down or rebooting may lead to restarting a crashed file-encryption process and potential loss of encryption keys stored in the memory.  

Experts instead recommend that victims just hibernate their computer(s) and disconnect it from their network. (Easiest way is to pull out the network cable from the back of it, if it is hardwired to the internet). If you suspect more than one machine is affected, disconnect the office network switch(s), and cut its connection to the internet to keep the infection from spreading further if possible. Once done, it is advised to reach out to a professional IT support firm for further steps. 

Victims should take note that there are two stages of ransomware recovery process they must go through. 

The first is finding the ransomware’s artifacts — such as processes and boot persistence mechanisms — and removing them from an infected host. 

Second is restoring the data if a backup mechanism is available. 

When companies miss or skip the first step, rebooting the computer often restarts the ransomware’s process and ends up encrypting the recently restored files, meaning victims will have to restart the data recovery process from scratch. 

In the case of enterprises, this increases downtime and costs the company operating profits. 

To learn more about dealing with ransomware attacks, you can check out the Emsisoft guide on how to remove ransomware and Coveware’s first response guide on dealing with a ransomware attack. 

Above all please keep up with regular training and remind your employees and co-workers, not to click on any questionable links or download anything that they are not sure of. Stress that if they should ever question something, it is always best to just ask their IT department about it first. While it might create more work to make sure something is legit or safe for you to use, it will tremendously save the company in the long run from massive expenses incurred from getting infected by ransomware. 

Stay safe out there everyone. 

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 .   

HIPAA Certification, To Do or Not To Do

Catherine Beasley, MS, BSN, LNCC 
Dec 2020 

Breaches of protected health information are becoming commonplace.  The US Department of Health and Human Services, Office for Civil rights now publishes a Breach Report Results which can be accessed at https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf.   

Hospitals and health care organizations must report breaches affecting more than 500 people to the Department of Health and Human Recourses as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.  A breach of more than 500 patients’ information may result in the organization’s name on the Department of Health and Human Resources website.  Simply stated, breaches of protected health information are bad for the business of health care organizations.  Patients are left to wonder about the ability of the organization to provide safe, effective care.  After all, if an organization can’t manage paper, how can they manage safe care?   
 
The Health Insurance Portability and Accountability Act (HIPAA) training is now available online by third party vendors.  Training can be done at the convenience of the trainee and both individual and corporate rates are provided.  Seminars ranging from one or two days are also offered nationwide and pricing varies by vendor.   

The Department of Health and Human Services is very clear in that breaches of protected health care information are unacceptable regardless of the number of victims impacted.  However, does having a HIPAA certification mean an organization is better able to secure the personal data of those they serve?  There are two schools of thought to consider.  First, the training and knowledge will support safe practice and thus decrease risk of any potential breaches.  Training will also increase the confidence level of staff in managing protected health information and recurring training allows the trainee access to up to date information regarding HIPAA.   

An opposing view is that the Department of Health and Human Services does not endorse or recognize HIPAA certifications regarding security rules and warns against misleading marketing claims.   

“We have received reports that some consultants and education providers have claimed that they or their materials or systems are endorsed or required by HHS or, specifically, by OCR. In fact, HHS and OCR do not endorse any private consultants’ or education providers’ seminars, materials or systems, and do not certify any persons or products as HIPAA compliant.” 

The HHS website goes on to reflect:  

“There is no standard or implementation specification that requires a covered entity to “certify” compliance. The evaluation standard § 164.308(a)(8) requires covered entities to perform a periodic technical and non-technical evaluation that establishes the extent to which an entity’s security policies and procedures meet the security requirements. The evaluation can be performed internally by the covered entity or by an external organization that provides evaluations or “certification” services. A covered entity may make the business decision to have an external organization perform these types of services. It is important to note that HHS does not endorse or otherwise recognize private organizations’ “certifications” regarding the Security Rule, and such certifications do not absolve covered entities of their legal obligations under the Security Rule. Moreover, performance of a “certification” by an external organization does not preclude HHS from subsequently finding a security violation. 

Given certification is not mandatory it is up to an organization to ensure compliance is achieved.  Investment in training, while not required, is an organization decision based on the level of comfort and ability to meet requirements.   

Breach Portal, (n.d.).  Retrieved 23 Nov 2020  from https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf 

HHS.gov. (n.d.).  Are we required to “certify” our organization’s compliance with the standard security rule?  Retrieved 23 Nov 2020 from https://www.hhs.gov/hipaa/for-professionals/faq/2003/are-we-required-to-certify-our-organizations-compliance-with-the-standards/index.html 

HHS.gov. (n.d.) What you should know about OCR HIPAA privacy rule guidance materials.  Retrieved 23 Nov 2020 from https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/be-aware-misleading-marketing-claims/index.html