Texas Provider Letter re: Surveyor Electronic Records Access

Texas Health and Human Services (HHS) issued a new LTC Regulatory Provider Letter PL 18-10 (NF) which replaces existing PL 17-20. This letter outlines the requirements that providers must understand so that surveyors can have timely access to electronic health records (EHRs) on both surveys and complaint investigations. The contents of this letter provide good hints/ things to consider for providers in all states regarding their survey readiness in order to not delay surveyors access to needed information.

Providers need to ensure that surveyors have alternate means of arranging for surveyors to have access to EHRs if there is limited or no network availability or the surveyor cannot access the system. This includes:

  • Providing access to all EHRs requested by surveyors, preferably in read-only format so no changes are inadvertently made. The Texas PL notes that if the survey process is “unnecessarily” delayed or access to a resident’s medical record is restricted, it can result in termination from Medicare/ Medicaid or a licensure action.
  • If the EHR is web-based, surveyors have the ability to access the records from their laptops/ tablets, but the facility needs to provide temporary wi-fi access. The letter recommends that a single password is set for surveyors to utilize for the duration of the survey instead of temporary passwords that require surveyors to request a new password each time they login.
  • If wi-fi access is not available, then surveyors must be provided with alternate means of accessing the EHR, such as terminal access.

Per an August 14, 2009 CMS S&C memo, “Surveying Facilities That Use Electronic Health Records (EHR)” (Ref: S&C-09-53), the Centers for Medicare & Medicaid Services (CMS) require providers to do the following:

  • Provide surveyors with a tutorial on how to use its particular EHR
  • Designate an individual to help surveyors, upon request, access the EHR, answer questions or provide assistance
  • Provide a terminal (or terminals to reduce delays) where surveyors can access records
  • Provide direct print capability to surveyors or make available a printout in a timely manner of any record that is requested by a surveyor
  • As mentioned above, provide read-only access to avoid surveyors making inadvertent changes to a medical record

Per the LTCSP Entrance Conference Worksheet, facilities must provide surveyors will access to all resident electronic health records by the end of the first day of survey, including providing information on how surveyors can access the EHR outside of conference rooms. A form is provided for the facility to fill out that includes use instructions.

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