Incomplete Medical Charts: Impacts And Possible Solutions

Introduction

Proper documentation and relevant updating of patients’ health status has become a cumbersome task with the inception of electronic medical records.Inpatient, ED, and ambulatory patient evaluation generate billions of records each year.It brings about a burden on the workload of the providers regarding registering and completing patients’ records.Incomplete medical records set up complications in patient management and subsequent administrative operations.Specifically, denials for reimbursement because of incomplete medical records emerge as a critical concern.Effective measures, consisting of both technical and administrative enforcements are required to reduce number of open charts.

Objectives

To understand the reasons,consequences and solutions for Incomplete/Delinquent medical records.

Methods

We searched Google scholar and Pubmed database using keywords “Incomplete medical records”, “Imapacts” and “Solutions”.Articles popped up.We selected 4 based on internal and external validity.

Results

Incomplete/Delinquent medical records are nowadays imposing a critical challenge upon financial, administrative and legal affairs in practicing Medicine.Our review shows that CMS recovery audit with hospital denials went high from 7-10% in recent years because of open/incomplete medical records.Provider’s documentation time increases as well with implementation of EHR.Appropriate measures could be taken to resolve this issue, broadly we can try two ways- training and administrative courses.

Conclusions

Physicians,residents and all respective providers should get training on a regular basis regarding EMR/EHR to complete medical records duly and effectively.The other way is administrative surveillance.If providers fail repeatedly to comply with HIM standard and complete delinquent medical records, warnings, suspensions or other regulatory actions can be executed strictly to keep them on track.

Disclosure

No significant relationships.

Context-dependent expression of the foraging gene in field colonies of ants: the interacting roles of age, environment and task

Task allocation among social insect workers is an ideal framework for studying the molecular mechanisms underlying behavioural plasticity because workers of similar genotype adopt different behavioural phenotypes. Elegant laboratory studies have pioneered this effort, but field studies involving the genetic regulation of task allocation are rare. Here, we investigate the expression of the foraging gene in harvester ant workers from five age- and task-related groups in a natural population, and we experimentally test how exposure to light affects foraging expression in brood workers and foragers. Results from our field study show that the regulation of the foraging gene in harvester ants occurs at two time scales: levels of foraging mRNA are associated with ontogenetic changes over weeks in worker age, location and task, and there are significant daily oscillations in foraging expression in foragers. The temporal dissection of foraging expression reveals that gene expression changes in foragers occur across a scale of hours and the level of expression is predicted by activity rhythms: foragers have high levels of foraging mRNA during daylight hours when they are most active outside the nests. In the experimental study, we find complex interactions in foraging expression between task behaviour and light exposure. Oscillations occur in foragers following experimental exposure to 13 L : 11 D (LD) conditions, but not in brood workers under similar conditions. No significant differences were seen in foraging expression over time in either task in 24 h dark (DD) conditions. Interestingly, the expression of foraging in both undisturbed field and experimentally treated foragers is also significantly correlated with the expression of the circadian clock gene, cycle. Our results provide evidence that the regulation of this gene is context-dependent and associated with both ontogenetic and daily behavioural plasticity in field colonies of harvester ants. Our results underscore the importance of assaying temporal patterns in behavioural gene expression and suggest that gene regulation is an integral mechanism associated with behavioural plasticity in harvester ants.

Differential regulation of the foraging gene associated with task behaviors in harvester ants

Background

The division of labor in social insect colonies involves transitions by workers from one task to another and is critical to the organization and ecological success of colonies. The differential regulation of genetic pathways is likely to be a key mechanism involved in plasticity of social insect task behavior. One of the few pathways implicated in social organization involves the cGMP-activated protein kinase gene, foraging, a gene associated with foraging behavior in social insect species. The association of the foraging gene with behavior is conserved across diverse species, but the observed expression patterns and proposed functions of this gene vary across taxa. We compared the protein sequence of foraging across social insects and explored whether the differential regulation of this gene is associated with task behaviors in the harvester ant, Pogonomyrmex occidentalis.

Results

Phylogenetic analysis of the coding region of the foraging gene reveals considerable conservation in protein sequence across insects, particularly among hymenopteran species. The absence of amino acid variation in key active and binding sites suggests that differences in behaviors associated with this gene among species may be the result of changes in gene expression rather than gene divergence. Using real time qPCR analyses with a harvester ant ortholog to foraging (Pofor), we found that the brains of harvester ant foragers have a daily fluctuation in expression of foraging with mRNA levels peaking at midday. In contrast, young workers inside the nest have low levels of Pofor mRNA with no evidence of daily fluctuations in expression. As a result, the association of foraging expression with task behavior within a species changes depending on the time of day the individuals are sampled.

Conclusions

The amino acid protein sequence of foraging is highly conserved across social insects. Differences in foraging behaviors associated with this gene among social insect species are likely due to differences in gene regulation rather than evolutionary changes in the encoded protein. The task-specific expression patterns of foraging are consistent with the task-specific circadian rhythms observed in harvester ants. Whether the molecular clock plays a role in regulating foraging gene expression (or vice versa) remains to be determined. Our results represent the first time series analysis of foraging gene expression and underscore the importance of assaying time-related expression differences in behavioral studies. Understanding how this gene is regulated within species is critical to explaining the mechanism by which foraging influences behavior.