Electronic health records (EHRs) are standard across medical practices today, as mandated by the federal government. But while this high tech approach to medical records seemed like a good idea at first – records could easily be transferred between providers and patients wouldn’t have to gather piles of papers to share their medical histories – EHRs haven’t been nearly so successful in practice. In fact, in an attempt to improve the flow of important information, EHRs may have actually made doctors more vulnerable to malpractice cases.
The Roots Of Risk
In order to understand how EHRs impact healthcare, CRICO Strategies performed a retrospective analysis of EHR-related errors, and identified five primary causes: user error, incorrect internal information, copy-paste or pre-populating errors, problems with conversion between paper and electronic records, and design flaws, representing between 17% and 12% of errors respectively. What this set of root causes reveals is that EHR manufacturers still need to resolve a number of key problems with their programs and/or devices, while doctors also need to be better trained regarding how to use EHR programs in order to best treat patients.
Multiple Providers Multiply Risks
One of the primary goals of transitioning healthcare providers to EHRs was to help doctors collaborate across practices, and this is particularly important for medically complex individuals. In order for doctors to effectively collaborate, though, their EHRs need to be interoperable, meaning that they can be used together. When practices rely on different systems, they may struggle to communicate key information, data may be dropped from the record in transport, and ultimately the patient may face improper treatment. The fact is that despite the federal mandate for their use, there are very few standards controlling EHR design; that element relies on private industry decisions.
Malpractice In Digital Context
With so many problems at play, can doctors really be held at fault for improper care stemming from EHR errors? This is one of the biggest questions troubling healthcare providers and the legal system today.
Ordinarily, in order to claim malpractice, the patient must be able to show duty of care – that there was an established relationship between the patient and doctor that led to treatment; breach of duty, or the failure to meet the standard of care or that the doctor did not act in a way that would be considered “reasonable;” and finally, that the injury was a direct result of treatment.
EHRs have no bearing on the first element of this triad; the relationship between patient and doctor is independent of technical issues. The second point, however, can be more challenging to prove from a legal perspective. It is, for example, reasonable for a doctor to act based on the information contained in the patient’s records, meaning that patients may not have standing to sue due to record errors. Errors stemming from improper use of the EHR, however, may prove a more serious problem.
The Problem Of Proper Use
If doctors are to avoid malpractice suits related to EHRs, they need to be rigorously trained on how to use the devices properly. For example, in one study researchers found that EHRs significantly increased “alert fatigue” in doctors, a result of the need to manage countless messages, reminders, and warnings from the program. This can cause doctors to dismiss important alerts, such as medication interactions or patient allergies as identified by the HER. Is this fatigue the result of doctors using the EHR improperly and failing to make use of available information or does it stem from poor design on the part of the developers?
Additionally, since EHRs suffer from a variety of design issues that compromise information accuracy, doctors have revealed that they modify information in the record, including test results. In one court case, a doctor explained to the judge that, “the EMR allows us to massage the data to filter out items so we can create flow charts and graphs.” In this particular case, the doctor had missed an abnormal urinalysis, leading to a failure to diagnose kidney disease. Though the doctor may have simply been using the EHR as instructed to create a more complete view of the patient’s health, he also failed to read a standard lab properly. In this way, EHRs complicate an already difficult job.
It’s hard to pin all fault in malpractice cases on either EHRs or doctors; both have a role in harming patients. As it stands, though, patients can’t confront EHRs in the court of law. Though they could potentially file a class action suit against various manufacturers, doctors face the brunt of patient anger and blame when things go wrong. For now, then, doctors must take added precautions in order to prevent medical errors. Read the labs twice, check the radiographs, and confirm all allergies and medications. Most of all, assume potential problems. The buck stops with you.
