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EMR Issues That Generate Med Mal Payouts Sound Familiar

Posted on February 8, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When any new technology is adopted, new risks arise, and EMR systems are no exception to that rule. In fact, if one medical malpractice insurer’s experience is any indication, EMR-related medical errors may be rising over time — or at least, healthcare organizations are becoming more aware of the role that EMRs are playing in some medical errors. The resulting data seems to suggest that many EMR risks haven’t changed for more than a decade.

In a recent blog item, med mal insurer The Doctors Company notes that EMR-related factors contributed to just under one percent of all claims closed between January 2007 through June 2014. Researchers there found that user factors contributed to 64% of the 97 closed claims, and system factors 42%.

The insurer also got specific as to what kind of system and user factors had a negative impact on care, and how often.

EMR System Factors: 

  • Failure of system design – 10%
  • Electronic systems/technology failure – 9%
  • Lack of EMR alert/alarm/decision support – 7%
  • System failure–electronic data routing – 6%
  • Insufficient scope/area for documentation – 4%
  • Fragmented EMR – 3%

EMR User Factors

  • Incorrect information in the EMR – 16%
  • Hybrid health records/EMR conversion – 15%
  • Prepopulating/copy and paste – 13%
  • EMR training/education – 7%
  • EMR user error (other than data entry) – 7%
  • EMR alert issues/fatigue – 3%
  • EMR/CPOE workarounds -1%

This is hardly a road map to changes needed in EMR user practices and system design, as a 97-case sample size is small. That being said, it’s intriguing — and to my mind a bit scary — to note 16% of claims resulted at least in part due to the EMR containing incorrect information. True, paper records weren’t perfect either, but there’s considerably more vectors for infecting EMR data with false or garbled data.

It’s also worth digging into what was behind the 10% of claims impacted by failure of EMR design. Finding out what went wrong in these cases would be instructive, to be sure, even if some the flaws have probably been found and fixed. (After all, some of these claims were closed more than 15 years ago.)

But I’m leaving what I consider to be the juiciest data for last. Just what problems were created by EMR user and systems failures? Here’s the top candidates:

Top Allegations in EMR Claims

  • Diagnosis-related (failure, delay, wrong) – 27%
  • Medication-related – 19%
    • Ordering wrong medication – 7%
    • Ordering wrong dose – 5%
    • Improper medication management – 7%

As medical director David Troxel, MD notes in his blog piece, most of the benefits of EMRs continue to come with the same old risks. Tradeoffs include:

Improved documentation vs. complexity: EMRs improve documentation and legibility of data, but the complexity created by features like point-and-click lists, autopopulation of data from templates and canned text can make it easier to overlook important clinical information.

Medication accuracy vs. alarm fatigue: While EMRs can make med reconciliation and management easier, and warn of errors, frequent alerts can lead to “alarm fatigue” which cause clinicians to disable them.

Easier data entry vs. creation of errors:  While templates with drop-down menus can make data entry simpler, they can also introduce serious, hard-to-catch errors when linked to other automated features of the EMR.

Unfortunately, there’s no simple way to address these issues, or we wouldn’t still be talking about them many years after they first became identified. My guess is that it will take a next-gen EMR with new data collection, integration and presentation layers to move past these issues. (Expect to see any candidates at #HIMSS16?)

In the mean time, I found it very interesting to hear how EMRs are contributing to medical errors. Let’s hope that within the next year or two, we’ll at least be talking about a new, improved set of less-lethal threats!

Photo IDs as Part of the Patient Record – Flashy Trend or Future of Medicine?

Posted on June 5, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Some time ago I read about the sad case of a toddler who underwent surgery for lazy eye correction, only the ophthalmologist “corrected” the good eye instead of the lazy one. Apparently she realized her error mid way and fixed the lazy eye as well. The child’s mother learned of this later.

I find many categories of lawsuits to be frivolous (that infamous hot, scalding coffee case anyone?) but if the parents ever had a strong case against a doctor, Jesse Matlock’s parents certainly did. But reactionary impulses aside, I’ve been thinking about how such errors can be prevented.

ICD-10 coding for example offers laterality info, but its implementation is still a-ways from becoming reality. Also ICD codes simply help you or your organization bill appropriately. If you need laterality information in any stage prior, you’re probably dependent on your trusty clinical notes.

Today Reuters had an article about patient photos as part of hospital records. Apparently it’s being tried at Children’s Hospital in Colorado. When a child is brought in for treatment, his or her digital image is added as part of the medical record.

Reuter reports that compared to 12 occurrences of mistaken orders in 2010 (in which treatment intended for one patient was performed on another) the number had fallen to 3 in 2011. All three of the cases involved children whose photos were not added to their medical records on arrival. There are similar feel-good statistics on near miss cases in which another worker caught a medical error put in place by a colleague (33 near misses in 2010, 10 in 2011).

The Reuters article notes CH, Colorado sees something like 13500 patients a year. The improvement in numbers after photo ids might not seem like much but each error prevented helps us gainthat much more confidence in our care providers. The article states that some parents refuse photo ids for kids out of privacy concerns. Let’s face it, this is for a loftier purpose than a child modeling. One workaround could be to discard the patient’s ID soon after the encounter is complete.

While the article doesn’t explicitly discuss laterality, that too could be a possible use for photo ids, if maybe the photo can be marked to point out surgery sites for example.

In terms of cost, digital photography has never been more affordable than now. For a couple of hundred dollars you can buy a good quality digital camera and its needed accessories. Basic photo editing software can assist with keeping image sizes manageable. The big downside I see is that it increases the workload somewhere along the encounter – someone needs to take these pictures and upload them, and knowing how things roll downhill, it might well be the already harried nurses and aides.

But the payoffs to quality healthcare could be enormous. So what do you think – has the time come for this idea?

EMRs And Malpractice Liability: Some Questions

Posted on February 19, 2011 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If things go as planned,  EMRs will prevent a multitude of medical errors from happening.  They’ll make sure patients don’t get the wrong drug or dose, help avoid interactions, alert clinical staff to key issues that emerge in real time from monitoring devices and more.  The sky is pretty much the limit here.

The thing is, who will be judged responsible when something goes wrong — and it’s the EMR’s “fault”?  For example:

*  What if the EMR somehow sends along data on the wrong patient (a possibility given the massive amount of systems integration issues involved in presenting the data)?  If the patient is harmed, is the doctor liable?

*  If a doctor doesn’t  fully understand the EMR interface, and records that a patient who’s violently allergic to a drug is not, who’s responsible if the patient gets that drug?  The doctor? The intern who relies on that record? The specialist called in to consult on the case and gets bad information? No one?

* What if a physician fully documents a patient’s status, correctly, but somehow the record gets altered by another user — and a patient  is harmed?  Is the second user responsible?  The IT department? The doctor?

These aren’t trivial questions, but I’m betting med mal insurers haven’t a clue how to handle them, much less physicians. I’m fully  expecting the first big malpractice case involving an EMR to surface shortly.   It’ll be a nightmare.