Legal Lesson of the Month: Automatic Narratives

EMS can be full of interesting and tricky legal scenarios. While you can’t have an attorney ride with you, it behooves providers to have at least some familiarity with the principles, precedents, and major issues of EMS law. To that end EMS World is pleased to offer the EMS Legal Lesson of the Month.

These cases are presented by leading attorneys in the EMS field. This month’s comes from G. Christopher Kelly, an attorney with the prominent EMS law firm Page, Wolfberg & Wirth and a member of EMS World's editorial advisory board. 

Occasionally I get asked whether EMS agencies should use automatically generated narratives. My answer is, “It depends.” You might expect that kind of noncommittal answer from a lawyer, but what I mean is that it depends on you. Much like any tool, this one has proper and improper uses. An autogenerated narrative must be used just like a pen, stylus, or keyboard—it is merely a method of data input that depends on the person behind it.

Many patient care reporting software applications offer the autogenerate feature. Basically this feature takes information you enter in one portion of the application and places it in a sentence format in the narrative field. However, whether the use of autogenerated narratives is appropriate depends on the policies and practices of individual ambulance services. There is nothing wrong with making templates for documentation; ambulance services have long used this approach (SOAP, SAMPLE, CHART, DRATT, etc.) to make sure we cover every required piece of the picture. And there’s no reason we can’t populate the narrative field with data we’ve already entered into another section of the trip report (gender, blood pressure, GCS, etc.) to prevent the necessity of duplicate entry. There isn’t even anything that says we can’t use standard language in the narrative field depending on the type of transport (specific templates for cardiac emergencies, hospital transfers, etc.). In fact, the accuracy of narratives can be controlled by how carefully such a template is drafted. 

However, at the end of the trip, it’s up to the crew to review and revise the narrative, just as it’s up to the crew to write a narrative when one isn’t autogenerated. When crews get lazy and don’t review what’s put into the narrative field, it could lead to an incomplete or inaccurate narrative. So how the crews use the template is the key. If they take it for what it’s intended to be—assistance with an outline and a time-saving device—and they review and revise it after inputting the underlying information, then autogenerated narratives are a wonderful tool. On the other hand, if crews get lazy and don’t review their narrative at the end of the trip, then it’s up to internal controls to catch that failure and retrain the employees—or just turn the autogenerate feature off and force them to write from scratch.

If you’re not already covering this in your QA process, I encourage anyone using autogenerated narratives to periodically review their use and make sure crews are properly completing, reviewing, and revising their final narratives.

G. Christopher Kelly is an attorney with the law firm of Page, Wolfberg & Wirth, which focuses on the ambulance industry. He writes regularly for EMS World and sits on the magazine’s editorial advisory board. Reach him at ckelly@pwwemslaw.com.