The National Coordinator of Health Information Technology and the American Hospital Association reports show that at least 84% of the non-federal U.S. hospitals have at least a basic electronic health record system in place. Electronic health records (EHR) systems, also known as electronic medical record systems, should assist in preventing errors associated with medical malpractice claims by providing a central source for patient data. Unfortunately, the EHRs demonstrate some vulnerability. Alan Lembitz, MD, and Chief Medical Officer for COPIC, a liability insurance carrier, explained that if a doctor enters a patient note at 10PM, it is assumed that the subsequent doctor at 7AM will access that information and continue with care accordingly. Unfortunately, this assumption is often not the reality, as providers may not access the information or overlook it based on confusion in interpreting the often complicated formats of these systems.
There are many ways that EHR systems can be harmful in terms of the potential for medical malpractice. Data such as lab results may be sent to the wrong recipient, or sent to the correct recipient, yet their EHR system may not be compatible. Some of the systems lack compatibility unless an interface is present. In many of today’s larger hospital systems, compatibility concerns have been addressed so all internal units are aligned; however, they may not be in concert with outside labs, pharmacies and imaging and surgery centers. According to COPIC, the EHR systems themselves are rarely the cause in malpractice incidents; rather it is improper usage or failures in training.
Medical Economics (ME) recently provided some commons errors that create significant potential for liability as follows:
- Dosages of two medications are accidentally switched in the system—i.e. one is for asthma and one for pain management
- The system fails to adjust for or generate an alert when a small child’s weight has changed significantly, which may require dosing changes
- Critical lab results were received; however, there was no indicator of receipt
- A decimal place inaccuracy led to a significant insulin dosage disparity
- Scanned documents were placed in the record of the daughter instead of the mother with same name
Ensuring standardization within EHR systems is important in reducing the potential for errors. For example, the layout of software may appear to be similar, yet the menus and buttons may do totally different functions. The standards are often implemented by healthcare management and administration, without input from day-to-day users. The way a physician interacts with the software is notably different compared to billing staff. When a problem is detected, an IT vendor may correct the concern at hospital A, yet may fail to correct the concern system-wide, particularly if not contracted to do so with the other providers. ME concludes that a collaborative effort must be made by involving all users including physicians, administration, vendors, payees etc.
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