Electronic Medical Records Increase Potential Liability for Physicians

Guest post by Keith L. Klein, MD, FACP, FASN.

The use of electronic medical records (EMRs) is increasing liability risks for physicians. We have not yet seen the full impact of EMRs, because cases take three to four years to be filed from the time of the adverse event. However, we are beginning to see data that show EMRs are a contributing factor in malpractice suits.

In a study by The Doctors Company of 97 EMR-related closed claims from 2007 to 2014, user factors contributed to 64 percent of claims, while system factors contributed to the remaining 42 percent. EMRs can result in a weak defense by casting the user—the physician—in an unfavorable light.

In a recent presentation I gave at HIMSS, I outlined malpractice cases that involved EMRs that resulted in cumulative awards of more than $30 million and reviewed areas where EMRs present the greatest risks.

Risk 1: Copy-and-Paste

Copying and pasting previously entered information can perpetuate any prior mistakes or fail to document a changing clinical situation. In The Doctors Company study, 13 percent of cases involved pre-populating/copy-and-paste as a contributing factor. While it may be OK to use the copy-and-paste function to save time, whatever is pasted must also be edited to reflect the current situation. Similar to copy-and-paste is the practice of using templates. Some of the biggest pitfalls in these two functions are lack of individualized information on the patient, gender confusion, lengthy notes for each encounter that look like they have been enhanced by the computer, lots of blanks, repeated typos and other errors, and use of similar phrases sequentially.

Risk 2: Informed Consent

Physicians must take care to capture the electronic signature of the patient when loading an informed consent into the EMR. Make certain the signature is legible. Also check to be sure the scanned document is in the record and that the informed consent is documented in the notes.

The following is from a case that involved problems with informed consent in the EMR:

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The Blinding Snowstorm of Alert Fatigue: Three Keys to Improved Medication Alert Effectiveness

George Robinson
George Robinson

George Robinson, RPh, senior product manager, First Databank.

Approximately $20 billion is lost annually in the United States because of medication errors, with the average hospitalized patient subject to at least one medication mistake per day.Alert fatigue is often cited as a reason for these errors—even though alerts generated by clinical decision support (CDS) systems call attention to important information (such as potential drug interactions), excessive alerts wear clinicians down, resulting in boy-who-cries-wolf scenarios. The result: clinicians instinctively override the alerts instead of implementing an override monitoring plan.

Consider the following:

A Driver in Need of a Clearer View

The afore-mentioned studies conclude that clinicians are indeed overriding medication alerts at alarming rates. Although the industry has made significant progress in addressing alert fatigue during the time the data from these studies was being analyzed, these studies clearly support what most healthcare professionals already suspect: The practice of ignoring and overriding medication alerts is widespread and can potentially lead to undesirable consequences.

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