On a web board today a risk manager asked about what he understood to be common ED practice — looking up patients on the internet during their visit. He wanted to know if there were legal implications, especially if the person you find is not the person who is the patient.
Let’s get right to my answer — if you are using a web search (differentiated from accessing an electronic health record) while you have patients waiting for care, you are going to have a very difficult task to justify the delay or inattention to the patient to a jury or an EMTALA investigator. That will be doubly true if you make some sort of a medical or financial decision based on that web search. If you base an action on the wrong online information, the consequences could be legally devastating. EMTALA investigators generally look for prompt assessment and care of the presenting patient, and delays generated by looking up the patient on the internet are likely to draw EMTALA citations based on the potential for possible injury to a patient while lawsuits require actual harm to occur.
Of less legal importance, but of definite financial importance, patients (especially the younger adults and kids) definitely would pick up on the electronics use, and patient satisfaction levels will definitely suffer.
Now, I have not personally seen ED staff doing this, but I have seen staff on obvious private phone calls or playing games on their smart phones while patients have waited for appropriate attention, so it may also be occurring. Most states are passing laws about inattentive driving and documenting the accidents, injuries, and deaths associated with the practice. This question raises the issue is it time to ban inattentive patient care — especially in the ED?
You really missed the real question. Internet searches are done in EDs to look for patients using fraudulent names or addresses. Google map searches of their given address can confirm if it really is a house or an industrial park. Facebook can be used to see if they are suing someone else’s identity. Doing this does not delay the EMTALA exam but may prevent a fraudulent patient from walking out with a prescription for an opioid that they plan to go sell on the streets.
If the medical screening examination has not been completed including necessary testing and consults, you are conducting a non-medical screening of the patient that pertains to means or ability to pay (or fraud involving means or ability to pay). Issues involving means or ability to pay, such as Identity or Insurance, are out of bounds under EMTALA until the MSE is fully completed. The patient does not have to give you a name to be entitled to EMTALA, they do not have to produce an ID, they do not have to give you an address, and if they lie about any of the above, that does not change their EMTALA rights one iota. The internet searches obviously address a valid business concern — but financial issues violate EMTALA until the MSE is completed. EMTALA was passed to prohibit business processes and decisions from deterring patients from ED medical care.
The REAL question — the exact question — was does this raise legal liability issues, and the answer is YES IT DOES.