Open Dental Forum

Question...does procedure locking also lock the comm log? We are in the process of (gradually) going paperless, and my thoughts were to do procedure locking after a period of time has passed (week, or month, say, after notes have had a chance to be reviewed) for medico-legal reasons, so I want to know what would be 'permanently' locked, and what isn't.

Thanks Much, Sam Barr

sam-I-am wrote:Question...does procedure locking also lock the comm log? We are in the process of (gradually) going paperless, and my thoughts were to do procedure locking after a period of time has passed (week, or month, say, after notes have had a chance to be reviewed) for medico-legal reasons, so I want to know what would be 'permanently' locked, and what isn't.

Thanks Much, Sam Barr

There is no medico-legal worry with OD. While procedure notes aren't "locked" they can never be permanently deleted either. If you edit a note 1,2,3... times each version is saved and viewable from "audit" in the note window. Every deleted note is likewise not really deleted, it is just hidden from the Chart view. It is still in the database and viewable from "audit".
That security does not apply to comm logs and generally you shouldn't enter any clinically relevant information in a comm log. Clinically relevant information should be put in a clinical note. On the other hand, a comm log note can be signed, so if you use it to say you called the patient and she feels fine, and you sign it, then it is signed and dated and will most likely hold up medico-legally, because you can prove when you wrote the note and that you didn't alter it since then.

I think that almost anything could be considered 'clinically relevant' in a court of law, including any phone conversation held with a patient, which naturally go into comm logs.

So, then, does the same audit trail that exists with procedure notes also exist with comm logs? If not, then, I would like to have the ability to have the notes 'locked'. Notes can be inadvertently deleted. Although you may be able to prove that a note was not altered, you won't be able to prove it was deleted.

Sam Barr

sam-I-am wrote:...does the same audit trail that exists with procedure notes also exist with comm logs?

Procedure notes have a unique audit trail. Commlogs use the normal audit trail. http://opendental.com/manual/audittrail.html

sam-I-am wrote:I would like to have the ability to have the notes 'locked'. Notes can be inadvertently deleted. Although you may be able to prove that a note was not altered, you won't be able to prove it was deleted.

I don't understand, by locking the procedure, you have locked the notes. And if a procedure is deleted, thus deleting the "note", just look at the special Audit mode in the Chart and you'll see the deleted note. That way you can prove that a note was deleted.

Or, if you started loosely using the word 'notes' to in fact talk about commlogs, then use the CommlogEdit permission to stop users from deleting commlogs or view when any user has deleted commlogs in the normal audit trail.

You can edit CommLog permissions so that no one can delete a CommLog after a certain amount of time. This can be set to one day. What this means is a User with those permissions can delete a CommLog on the day it is entered, but after that day, it cannot be removed. You can set this by unchecking the CommLog Edit/CommLog Delete permission and then recheck it. When you give the permission back, Open Dental will prompt you to enter in a time limitation for those permissions.

The way I see it commlogs are meant to keep track of your less critical communications. If we communicate (by phone, text or e-mail) with a patient or third party regarding an appointment, insurance, bill, recall, then we use the commlog.
If we communicate with another doctor regarding a pt's medical or dental condition, or with a patient regarding their treatment or results, then we use a procedure note, so that it is subject to the unique audit trail that all procedure notes are subject to.
You can create a dummy code (Nxxxx) for your communications with other doctors and another one for patients.
If you do that, you shouldn't have to worry that commlogs don't have the same level of auditing that procedure notes have.
I delete a lot of the commlogs (confirmations, recalls) because I don't want them cluttering up my database with unneeded information. If you don't want to do that and you are worried that someone might delete something, set the permissions so no one can, as Arna said above. If you think something is important, sign it or have your staff sign it when they make the communication. Then you have proof that it hasn't been changed since the time you signed it. No matter how you look at it, there is more than enough security built in to OD.

If so, then why have procedure locking at all?

sam-I-am wrote:If so, then why have procedure locking at all?

It is never permanently locked. You can always edit or delete a procedure note. However, your changes will always be visible. You can't delete it from the database, only from the normal view of the chart. Any deletion and changes are always visible in audit mode. Hence the security.
Think of it like a paper chart. You are not allowed to white something out or discard a sheet of paper so that the previous note is not visible. However, you can always put a line through something you wrote previously, and write something else above it or on another piece of paper as long as the original note remains visible and you indicate when the addendum was written.