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!