title: Electronic medical record metadata: uses and liability.
abstract: BACKGROUND
  Minimal information exists concerning the use and liability of electronic medical record (EMR) metadata.
  
  
  METHODS
  We performed a retrospective review of Vista Imaging (VI) metadata concerning when and which images residents and medical students on a surgery service actually visualized; and the laws governing e-discovery were reviewed.
  
  
  RESULTS
  During a 5-month period, PGY III surgery residents logged in to VI 191+/-18.3 times; PGY II surgery residents logged in 164+/-34.3 times; and PGY I surgery residents logged in 92.0+/-14.8 times. Family practice residents logged in 21.0+/-4.6 times, and medical students logged in 32.0+/-5.7 times (p < 0.01). Surgery residents logged about once a day (1.0+/-0.06 log-ins/day); family practice residents (0.2+/-0.2 log-ins/day) and medical students (0.3+/-0.1 log-ins/day) logged about only once a week. CT scans were the most frequently viewed image: surgery residents viewed CT scans during 81.9+/-14.9% of Vista Imaging sessions to view 69.3+/-36.5 images (range 1 to 863 images); family practice residents viewed CT scans during 58.0+/-43.8% of Vista Imaging sessions to view 19.3+/-22.8 images (range 1 to 112 images); and medical students viewed CT scans during 89.8+/-30.3% of Vista Imaging sessions to view 24.4+/-6.3 images (range 1 to 95 images). Changes in the Federal Rules of Civil Procedure and the need to authenticate electronic medical records will mean more metadata will be discovered during litigation.
  
  
  CONCLUSIONS
  Electronic medical records metadata allow for creation of detailed physician profiles and will likely be used increasingly to discredit physicians during medical malpractice litigation.
authors.affiliation: VA Eastern Kansas Health Care System-Dwight D Eisenhower VA Medical Center, Leavenworth, KS 66048, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: McLean
authors.forename: Lori
authors.initials: L
authors.lastname: Burton
authors.forename: Chris C
authors.initials: CC
authors.lastname: Haller
authors.forename: Patrick B
authors.initials: PB
authors.lastname: McLean
mesh_terms: D003952:Diagnostic Imaging; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D016365:Liability, Legal; D016347:Medical Records Systems, Computerized / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States