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Eliminate illegibility with individual doc stamps

HIM Connection, December 6, 2005

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If your doctors have legibility problems and your transition to electronic solutions is a few years away, consider taking the rubber stamp route. Stamps can help fill in the illegibility gap as your facility transitions to electronic signatures and other high-tech solutions.

Rubber stamps offer you two options--authentication of an entry in place of a normal signature or identification of entry accompanied by the provider's written signature.

The Greater Community Hospital (GCH) in Creston, IA, opted for signature stamps to authenticate entries because GCH is small enough to avert some of the problems associated with stamps, such as ensuring that providers are the only ones using their own stamps, says HIMS Director Sharon Skarda, RHIT. Providers at GCH stamp their entries and do not need to sign in addition.

However, Skarda acknowledges that signature stamps may be impractical for some facilities, especially given security concerns in larger organizations. "In a larger facility, I think it would be harder to monitor," she says, adding that GCH has a staff of 14 and only four physicians use the signature stamp.

In addition, the JCAHO has a standard that addresses the use of signature stamps. IM.6.10, element of performance 5, specifies that all medical history and physical examination documents, operative reports, consultations, and discharge summaries must be authenticated by written signatures or initials, rubber stamp signatures, or computer key, says Jean Clark, RHIA, health information services director for CareAlliance Health Services in Charleston, SC.

Facilities that opt for rubber signature stamps must have an affidavit signed by the user ensuring that he or she alone will use the stamp or key. The affidavit is still not a guarantee, however.

If security worries keep you from choosing signature stamps, consider name stamps. Name stamps provide identification of an entry as opposed to authentication. They must be augmented by a signature or initials.

"We had decided that there were a lot of regulations for signature stamps having to do with how the providers keep them secure and safe," says Tricia Truscott, MBA, RHIA, CHP, HIM director at the Carle Foundation Hospital (CFH) in Urbana, IL. "So we made a decision that it was best to go with an identification and not an authentication stamp." Attending physicians and residents at CFH use the stamp and then sign above or underneath it.

Because the name stamps that CFH uses are authenticated by signatures, the stamps do not have to be secured by a signed affidavit, per the JCAHO standard, Clark says. Although she encourages the transition to electronic health records and other electronic solutions to illegibility, she does see name stamps as a helpful way to identify signatures.

The bottom line: "Take a look [at rubber stamps] as an option for your providers who just aren't responding to any of your legibility initiatives," Truscott says. Keep the following in mind as you implement the stamps:

• Cost. Truscott says the stamps are $20-$25 each from her vendor. That doesn't sound like much, but it can add up if your staff continually need to replace lost stamps.
• Communication. Make clear exactly what type of stamp-identification or authentication-you've chosen and how doctors must use them. Truscott says CFH initially had problems using the name stamps because some providers didn't realize they needed to sign as well as use the stamps.
• Method. Decide how you will determine who uses stamps and who doesn't. Physicians at CFH and GCH are not forced to use the stamps; they request them as an alternative to being hassled about illegibility, Truscott says. Make voluntary use of the stamps part of a larger illegibility initiative to ensure their acceptance.

Editor's note: This article was adapted from Medical Records Briefing, published by HCPro, Inc.

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