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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!

Hidden Legal Risks For Doctors In EMR Use

Posted on February 17, 2012 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.

Medicine is a risky business, and malpractice suits one of the nastier part of the trade. Whenever something major changes in the way medical care is delivered — including, say, the use of EMRs — it makes sense to expect the worst.

That’s exactly where Dr. Sam Bierstock stands. Bierstock, an interesting guy whose act includes a blues band performing songs on the perils of managed care and EMRs, is going national with his view that EMRs are opening up  bigger med mal liabilities than doctors realize.

“What few people realize is that using an EHR exposes physicians to an Orwellian level of analysis of every single act while doing their job,” writes Bierstock, who nonetheless sees himself as an EHR advocate.  As he rightfully notes, EHRs can be audited to see how long it took a physician to respond to an abnormal lab finding, to find out what doctors said in internal e-mails or even whether they scrolled down an entire screen before closing a document.

To my (admittedly limited) knowledge, there have not yet been any major lawsuits based actions doctors took which can be pinned specifically on the use of an EMR (other than, perhaps, HIPAA breaches). But it does seem credible that such suits are on the horizon. After all, not to be too cynical, but medical malpractice lawyers do work on commission, and if I were them I’d see this as an opportunity.

In his commentary, Bierstock argues that there must be “meaningful tort reform” before physicians can safely use EMRs. The question is what reforms are the right ones.  To date, I haven’t seen model legislation, much less a live bill, which directly addresses this issue.  Do any of you have more information to share, readers?

P.S.  OK, I was wrong about there being no case law on this subject. Here’s at least one example where a physician allegedly altered an EMR audit trail to make it appear that a problem had been flagged.

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.