EHRs Can Advance Good Medicine―If Doctors Are Aware of the Risks
The EHR has introduced patient safety risks and unanticipated medical liability risks. According to a new study, the number of EHR-related medical malpractice claims has risen over the past 10 years.
Factors Behind EHR Errors
For the most part, the EHR is a contributing factor in an EHR-related claim and not the primary cause. This and their low frequency (0.9 percent of all claims) suggest that EHRs infrequently result in adverse events of sufficient severity to develop into a malpractice claim.
When EHRs are a factor in a claim, the study showed that user factors (such as data entry errors, copy-and-paste issues, alert fatigue, and EHR conversion issues) contributed to nearly 60 percent of claims. As computer users, we all copy and paste. Therefore, it’s no surprise that time-pressured physicians embrace the same habits when using EHRs.
System factors (such as data routing problems, EHR fragmentation, and inappropriate drop-down menu responses) contributed to 50 percent of claims. EHR fragmentation was among the most prominent system factors, contributing to 12 percent of errors. This factor means that different components of a single patient encounter might not be located together in the EHR. Consequently, doctors must check in different places to find laboratory and x-ray results, histories and physicals, etc.—resulting in important information being overlooked or unidentified.
Re-Claiming the Doctor-Patient Relationship
One overwhelming response to adjust to burdens introduced by EHRs has been the rapid growth of medical scribes. Nearly 20 percent of medical practices are using scribes to help untether physicians from the EHR. Yet, according to a survey of hundreds of physicians from The Doctors Company, the lack of standardized training and variability in experience among scribes poses risks to data accuracy and delivery of care—which could increase liability for the patient and physician alike.
With or without scribes, lowering risk begins with each patient visit. At the beginning of each new session, doctors should inform patients of the purpose of the EHR and emphasize they are listening closely even though they might be typing during the appointment. Practices can set up treatment rooms so the patient can watch the screen and see what is being typed. It is also helpful to summarize or read the note to the patient to demonstrate that you have listened, and ask, “Do I have it right?”
What the Future Holds
As with any challenge of major proportions, progress will take time. But I’m optimistic that the EHR will evolve over the next 5 to 10 years and improve both the quality of medical care and patient safety.
Today, what I hear from The Doctors Company’s 80,000 member physicians is encouraging. Doctors are eager to “reclaim” their profession and refocus patient relationships amidst the new demands of today’s digital age. Into the future, new protocols, policies, and training programs must take these small successes to a large scale.
by David B. Troxel, MD, Medical Director, The Doctors Company
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 in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.