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A Physician's Perspective: Meaningful Use of Health Technology

Apr 19 2012   1:44PM GMT

How do electronic health records (EHRs) impact medical malpractice risk?

Posted by: DrJosephKim
EHR, electronic health record, malpractice

Let’s face it: many physicians are not excited about adopting electronic health records (EHRs). Unless you trained in a hospital and “grew up” using EHRs all your life, it’s a big adjustment and a major change to switch from paper charts to computers. I realize that there are some physicians who love EHRs because of the e-prescribing, the legibility of the notes, the populated problem lists, the built-in clinical decision support, the automated templates, the “copy and paste” (which no one does, right?), and a variety of other functions that improve the clinical workflow. But, there are enough physicians who dislike EHRs that they may even believe that EHRs negatively impact their risk for medical malpractice. Do we have any data on that? Or, are these all theoretical discussions at this point?

In 2010, the New England Journal of Medicine had an article titled, “Medical Malpractice Liability in the Age of Electronic Health Records.” In that article, the authors explored the “implications for malpractice liability of four core functionalities of EHR systems: documentation of clinical findings, recording of test and imaging results, computerized provider-order entry, and clinical-decision support.” What did they find back in 2010? They stated:

“The liability implications of EHRs are likely to vary over the life cycle of the adoption of these systems.”

During implementation, all sorts of things may go wrong, so we may find more medical errors. After you’re up and running, the authors note that “EHRs have the potential to reduce injuries and malpractice claims but will also create opportunities for error and will alter the context for proving and defending malpractice claims with the use of electronic information.”

So, do EHRs increase or decrease your medical malpractice risk? I think the answer is “it depends.” It depends on how effectively you are using your EHR and how well you document your clinical encounter. It also depends on how legal standards evolve as digital records become the norm within the industry. EHRs are creating new legal risks. At some point, it will be considered medical negligence to document a patient’s health information on a paper chart. We’re not there yet.

So, what does that mean today? I think the critical component is to encourage clinicians to leverage clinical decision support tools effectively so that they are delivering the best evidence-based care for their patients. They ought to be thorough in their documentation.  The use of “copy and paste” or templates could get you into trouble if you are not careful about your documentation.  Finally, be prepared to pull up a LOT of records the next time you have to go to court. Chances are, you will have much more digital data on a patient compared to the days when outpatient charts just had a few illegible scribbles written on a blank page. Don’t plan to rely on the “we can’t read the doctor’s handwriting” defense either.  The evidence will be clear and it will be abundant. Of course, this also means that the medical malpractice attorneys will probably need to spend more time combing through all the chart records that get generated (and I bet they will get printed on paper, so we’re back to square one – paper records).

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