“This study is an eye-opening report for doctors on the importance of having processes in place for back-up, cross-checking, and auditing the documentation in their EHRs.”
Technology is changing the way we practice medicine—bringing unanticipated consequences.
Currently, 80 percent of physician office practices and 90 percent of hospitals have adopted electronic health records (EHRs) to help optimize productivity, workflow, and communication.
At The Doctors Company, we’ve seen the number of closed claims in which EHRs were a contributing factor increase continuously over the past 10 years. While EHRs have brought many positives, they have also created new risks and frustrations for doctors and patients.
An Analysis of Electronic Health Record Closed Claims
In our study of 66 EHR-related claims from July 2014 through December 2016, we found that 50 percent of these claims were caused by system factors such as failure of drug or clinical decision support alerts and 58 percent of claims were caused by user factors such as copying and pasting progress notes.
This study was an update to our first analysis of EHR-related claims, a review of 97 claims that closed from January 2007 through June 2014.
The pace of these claims has grown over the past 10 years, from a low of 2 cases in 2007 to 2010 to 66 cases from July 2014 to December 2016.
From mid-2014 to 2016 there was an increase in EHR-related claim events occurring in patient rooms and fewer occurring in hospital clinics/doctors’ offices, ambulatory/day surgery centers, labor and delivery, and ERs.
Diagnosis-related allegations were the most common, increasing to 32 percent of all allegations, up from 27 percent in the earlier study.
The Dangers of Copying and Pasting
A physical medicine physician (PMP) followed a patient with extremity weakness due to a cervical vascular malformation. For four consecutive days, he entered identical progress notes into the hospital EHR, noting no change in symptoms, while nurses and physical therapists (PT) documented progressive neurologic changes. On the fifth day, PT spoke to the PMP regarding the patient’s deteriorating motor strength. The PMP ordered a neurosurgical consult but again entered the identical progress note into the EHR. The patient underwent decompressive surgery but now has incomplete quadriplegia. Defense experts concluded the identical progress notes resulted from copying and pasting.
“We’ll have to do three main things to make the EHR the vehicle that we want it to be. First is promoting for more use of user-centered design. The second is dealing with too many alerts—alert fatigue is overwhelming and dangerous, and we simply have to figure out how to prevent it. And the third is interoperability, to ensure that patient medical records can be shared easily between doctors, hospitals, and other healthcare providers at any time.”
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.