CHICAGO -- As electronic health record (EHR) use climbs, and even more health care information is stored in electronic systems, the legal implications of how that data is accessed and used continue to grow -- and provider organizations increasingly wonder how their liability is affected.
In the rush to adopt electronic health records and encourage EHR use, the medical industry hasn't fully considered how those systems are defined legally, said health care IT professionals at the 2011 Legal EHR Summit, held by the American Health Information Management Association (AHIMA).
The EHR itself, much less liability, is still hard to define, according to Adam Greene, a partner with Davis Wright Tremaine and former senior health IT and privacy specialist in the Office for Civil Rights. It's also difficult to regulate, Greene added. Fortunately, this leaves room for innovation in what's seen as the long process toward creating a learning health system. EHR adoption "is not the destination," he said in his presentation at the summit. "That is only the beginning."
It's getting beyond mere EHR use where medical liability becomes trickier. Providers are wary of how electronic information changes malpractice risk. A 2009 survey of physicians by the Center for Studying Health System Change indicates that most doctors believe they will be part of a lawsuit in the next 10 years, and that they must increasingly rely on technology, rather than their judgment, to help make clinical diagnoses and avoid malpractice threats.
It's all in the knowledge management.
Kimberly Baldwin-Stried Reich, information management and compliance consultant
Enter clinical decision support (CDS) systems, expected to be a major effort in stage 2 of the meaningful use incentive program. Decision support can be a valuable tool in clinical practice, but it comes with its own set of legal issues, according to Kimberly Baldwin-Stried Reich, an information management and compliance consultant. "It's all in the knowledge management."
Medication, allergy and drug reaction alerts are typical examples of decision support. But more than 95% of pop-up medical alerts can be ignored by alert-weary practitioners. "You have to think of the rules that are most important" to get providers to care about the information, Reich said during a presentation at the conference.
Nana Kwadwo Boadu, graduate student at the Johns Hopkins University Division of Health Sciences Informatics, described the CDS used at the health system. There is a synergy between informatics and IT, he said.
Among 18 dimensions of clinical decision support, designers must consider the following.
- Who is the target for the decision involved -- a single patient, or a population of patients? Will the decision be used retrospectively or concurrently?
- What is the decision to be made -- a diagnosis, for example, or care management? Is it a customized decision; if so, how was it triggered?
- Where will the decision be used -- in a single care setting or in multiple settings? Is the information accessible across a system, or will it be used locally?
- Is the data to be integrated with a repository or used in a standalone record? Will the decision be embedded into clinical workflow?
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