Electronic health records (EHRs) have fast become a staple in the healthcare sector and medical transcription companies play a key role in helping providers leverage EHR systems. However, EHRs have been found to contribute to malpractice suits. A new analysis by leading malpractice insurer The Doctors Company found that the number of malpractice claims in which EHRs have contributed to patient injuries has been rising during 2010-2018 (www.medscapecom). The trend is attributed to the increase in EHR adoption over these 8 years. As of 2017, nearly 9 in 10 (86%) of office-based physicians had adopted any EHR, and nearly 4 in 5 (80%) had adopted a certified EHR, according to the Health IT Dashboard.
In January 2018, we had reported on a Doctor’s Company study which found that the number of claims in which EHRs were a factor rose to 161 in July 2014 through December 2016 from just 2 (claims) during 2007-2010.
Researchers with The Doctors Company analyzed closed claims during 2010 to 2018 in their nationwide claims database. The report shows that:
- A total of 216 EHR-related malpractice claims were closed during the 8-year period
- The number of such claims rose from 7 in 2010 to an average of 22.5 in 2017 and 2018
- In 2018, these claims formed just .39% of the claims universe – up from 1.02% in 2017 and 0.35% in 2010
- Rather than being the primary cause of claims, EHRs are typically contributing factors
- System technology and design problems and user-related issues were the causes of the EHR components of claims closed from 2010 to 2018.
- Family physicians and internists face higher risk of malpractice suits than other specialists when EHRs a cause of patient injuries
- Serious injuries cited in EHR-related malpractice claims include death (25%), adverse reaction to medication (23%), need for surgery (15%), emotional trauma (14%), undiagnosed malignancy (13%), and organ damage (11%).
- 31% of the EHR-related malpractice claims involved diagnosis-related allegations
EHR System Failure and User Issues Top Causes of Malpractice Suits
The researchers reported that system failure and user errors are the top reasons for malpractice claims. The technology-related factors identified include:
- EHR failures (12%)
- Lack of or failure of an EHR alert or alarm (7%)
- A fragmented record (6%)
- Failure or lack of electronic routing of data (5%)
- Insufficient scope/area for documentation in the EHR (4%), and
- Lack of integration/incompatible systems (2%)
The report identified the key user-related issues that led to malpractice claims as:
- Entry of incorrect information (13%)
- Prepopulating/copy and paste (13%)
- Hybrid health records/EHR conversion issues (13%)
- Other user errors (12%)
- Insufficient training and/or education (7%)
- Alert issues/fatigue (2%), and
- Computer order entry workarounds (2%)
The study cited examples of how system failure and user issues led to malpractice suits. In one case, an elderly female patient was given the wrong medication – Flomax, a medication for enlarged prostates in men – instead of Flonase nasal spray which the physician meant to order. The EHR misinterpreted his abbreviation of “FLO” in the medication order screen as Flomax. However, according to an attorney, this is actually a case of human error which occurred because neither the doctor nor the pharmacist caught the mistake (www.medscape.com).
Another serious problem that the study identified is copy-and-paste. Looking into the death of a 38-year old obese patient from pulmonary embolism, experts found that the physician had not documented changes in his condition during visits. A previous note had been copied into the current one. The final visit progress note was the same as the earlier note made 3 months ago, including previous vital signs and spelling mistakes.
Clicking numerous drop-down menus during the course of a busy day can lead physicians to make some mistakes. When repeated across the organization’s system, pharmacies, and other providers’ EHRs, such errors can have grave consequences. Even if the physician corrects these errors, they many remain in other systems.
EHR-related Claim Risk Highest in Primary Care
The Doctors Company study found that family medicine and internal medicine had the highest percentage of EHR-related claims (8%), followed by: cardiology and radiology (6%); obstetrics, orthopedics, and nursing (5%); hospital medicine and gynecology (4%), and emergency medicine, anesthesiology, plastic surgery, urology surgery, and general surgery (3%).
The reason why risk of malpractice suits is higher for primary care physicians (PCPs) is because they tend to use the EHR more than other providers. PCPs see a comparatively larger number of patients and for a wider range of complaints. As a result, they are more likely to make errors related to cut-and-paste, drop-down lists, and prepopulation of EHR data.
Managing EHR-related Malpractice Risks
Electronic medical records are a desirable change, but come with many concerns, including professional risks. Patients complain about their physician focusing too much on the computer during the office visit instead of on them. While almost 90% of physicians are using these digital records, they complain about too much manual data entry, alert failure, and lack of standardization across systems.
Data that resides within the EHR can be used against the physician. As we have seen, ineffective EHR use and incomplete information can be used in a malpractice case to weaken the entire electronic patient record as well as the quality of patient care provided (www.medscape.com). Physicians should understand the system and be trained on how to use it. Medical transcription services from an experienced outsourcing company can ensure accurate and timely support for EHR documentation.