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Reviewing Audit Trails for Medical Malpractice Cases

You received an excel audit trail from the electronic health record, now what? Most small medical malpractice firms are not using a document management platform and do not receive load files or chain of custody documents. In these cases, EMR Discovery has compiled steps to quickly assess an audit trail.

Check the Document Properties and Inspect the Document

When receiving discovery in response to a production request, it is important to verify the integrity of the document by checking for the below items:

  • Assess the amount of excel audit trails received, files sizes, and file naming.

  • Open each file and check the file’s properties to identify the authors, created and modified dates.

  • Run the “inspect document” feature to check for hidden, missing or removed information.

  • Make sure that the file, cells or tabs have not been locked so that you can more easily review the file.

  • Check for redacted data.

Check Whether the Document is Responsive

Your audit trail discovery request likely had some components that should first be verified.

  • Were the dates provided from the date of the event to the present date?

  • Have all of the appropriate fields/column headers been provided (either in line with the request, vendor system, or federal audit regulation, such as ASTM E2147-13 which is referred to under 45 CFR 170.210)

  • Were any additional resources provided to help interpret the audit trail fields?

  • Were redactions identified and explained?

Format the Document for Easier Review

There are easy excel features that can help in making the review process much easier.

  • Add filters to the column headers so that you can use drop-downs for easier searching.

  • Sort the document chronologically by date/time in case the audit trail was not provided this way.

  • Format the rows and use text-wrapping so that each cell can be read.

  • Hide any redundant or irrelevant columns to reduce scrolling left and right.

  • Freeze the column row headers and the date/time and user name columns so the document is more user-friendly.

Reviewing the Audit Trail

Just like the medical record, the audit trail requires a detailed analysis to make an interpretation. However, more advanced excel functions (or additional programs) can assist in the review.

  • Search for key words (events and EHR functionalities) to identify pertinent data and further discovery

  • Create a pivot chart and table to separate column data and count entries.

  • Create separate tabs for pivot table lists, individual users, or timeframes.

  • Utilize pivot charts, Power BI, Tableau, or other visual analytic tools to create graphs and charts that better represent the data.

Having trouble getting started with audit trails at your firm? EMR Discovery offers audit trail reviews, support, and hands-on tutorial training for any firm interested in unleashing the potential of audit trails in their cases.


EMR Discovery offers healthcare litigation support services for plaintiff medical malpractice firms. EMRD's expertise includes EMR/EHR, Audit Trails, healthcare information systems, eDiscovery support, and analytical document review solutions. EMRD delivers a customized approach to fit each unique case.

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