EHR-related Medical Malpractice and How to Minimize Legal Risk
EHRs are helpful to doctors and facilitate medical record retrieval service, but are vulnerable. Certain strategies can help avoid malpractice risk.
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Electronic health record (EHR) systems are being increasingly implemented and used in healthcare organizations. Though EHRs have many benefits including the capability to schedule appointments and transfer relevant information among care providers, help doctors make more accurate diagnoses and treatment plans, improve processes such as medical record retrieval service and so on, they have certain vulnerabilities that could bring legal risks to healthcare providers. The Doctors Company,
a
Napa-based
medical
malpractice
insurance
company says that the increasing use of EHRs is causing an increase in medical errors and malpractice liability. This insurer settled almost 100 claims between 2007 and 2014 that were related to the use of EHR. Most of these claims were for diagnosis or medication related errors, the latter included errors associated with prescription, administration, and dosage mistakes. The Office of the National Coordination for Health Information Technology reports that the use of EHR increased 500% in non-federal acute care hospitals between the years 2008 and 2013. In 2008, only 9% of hospitals were using EHR systems whereas in 2013 these were in use in 93% of those hospitals. www.mosmedicalrecordreview.com
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What are the errors associated with EHR systems that carry malpractice risk? • Errors related to data entry • Health records stored in multiple locations • Patient records in multiple formats • Errors during digital conversion of paper health records • Copy-paste errors • System design failures such as outdated templates • Lack of interoperability • System failure • Insufficient documentation • Lack of EHR training This brings up a very important consideration – finding ways to mitigate the legal risks associated with the electronic health record. The best recourse, of course, is to be constantly aware of the possible risks and be cautious when performing EHR-related tasks. Here are some risk mitigation strategies that the Doctors www.mosmedicalrecordreview.com
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Company study recommends for physicians and clinicians that will help them avoid medical malpractice claims, minimize errors, and improve patient safety. • Before treating a patient, review all available health data very carefully: This is important to avoid taking any wrong step while prescribing medicines or charting out a treatment plan. • Exercise caution with e-prescribing: While e-prescribing is useful, there are many chances for error. Physicians must adhere to any alerts within the e-prescribing module of the EHR and make sure any actions they take are clearly documented. • Be cautious about copy-paste: It is best to avoid copypasting when describing the patient’s past medical history. Ensure that the documentation is objective, current, and relevant. • Make sure all alerts that could prevent an adverse event are followed: If physicians do not follow an alert, they could be held liable. So it is important not to disable or override any
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alerts in the EHR. Alert fatigue issues must be discussed with your IT department or your EHR vendor. • Understand that metadata in the EHR is as important as the notes logged in the system: All physician interactions with the EHR are time-tracked and discoverable. Any notes written after a patient visit should include the time of the interaction to avoid any suggestion of false or incorrect information. • Be cautious about the “autopopulate” issue: If you notice that the EHR’s autopopulation feature causes erratic data to be recorded, contact your IT department or vendor immediately. Make a note in the record that the autopopulated information is incorrect, and document the correct information. • Do not ignore autofill, templates, point-and-click lists and other canned text: Providers must utilize the tracking function in their EHR to ensure that consults and tests are completed, returned to the provider, and communicated to the patient.
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• Avoid data entry errors related to drop-down menus and other automatic features: Any wrong information entered into your EHR is easily disseminated and perpetuated. Therefore, providers should review their entry after making a choice from a drop-down menu. • Never share passwords, and be constantly vigilant regarding cybersecurity: Do not allow staff to use the physician’s password to review, update, or sign off on lab and imaging results. If this is allowed, there is a chance that a report is filed without the physician even seeing it. Providers should remember that even in cases where bad EHR design is responsible for the error, vendor contracts may have “hold harmless” clauses that attempt to put liability onto physicians. Some insurance policies may exclude coverage for product liability and indemnification of third parties. Typically, vendors choose to settle disputes out of court with nondisclosure clauses that prevent open discussion of the patient safety issues involved.
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EHRs are advantageous to personal injury lawyers and ease processes such as medical review services . They assist lawyers as they argue the case. Apart from viewing the actual medical records, attorneys can examine log in and log off times of clinicians, emails and smartphone records, and any changes or additions made to the data. This extensive information from the EHR makes it easy for them to identify issues such as inadequate or rushed treatment, privacy violations and careless medical record keeping. The benefits of EHRs are therefore undisputable. EHRs are still evolving, and alongside user awareness of the capabilities of the EHR is also evolving. Hopefully, we can expect a perfect electronic health record system in the not so far future.
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