One of the main selling points for EHRs, besides the incentives offered by CMS, is the opportunity to use digital know-how to catch patient safety errors before they cause real harm. But reports on the effectiveness of EHRs in that regard have been conflicting, with some research saying that EHRs are the cause of a host of new safety issues, and new research from JAMA, stating that EHRs have the potential to reduce malpractice cases related to diagnosis errors, does little to clarify the issue.
Malpractice insurance is one of the culprits of high healthcare costs, and finding ways to cut the errors that lead to lawsuits is a major focus of hospitals and regulators alike. To increase safety for patients, EHR systems are equipped with alerts, though some physicians ignore them, and come pre-filled with default values to save time and allow physicians to focus on the patient, though sometimes they cause more problems than they solve.
Some experts say they don’t even know the true impact of EHRs on medication errors, mixed-up files, improper treatments, and missing information. A conservative estimate by the Pennsylvania Patient Safety Authority revealed that 10% of EHR-related errors created “unsafe conditions” for the patients involved, and new data shows that 40% of medication errors are caused by incorrect EHR defaults or other erroneous data values.
While the instances that caused harm resulted in relatively minor problems, human error often leads to expensive and lengthy malpractice suits brought by the patient. Dr. Gordon D. Schiff and colleagues from Brigham and Women’s Hospital in Boston found in the JAMA article that high-volume outpatient offices, such as the larger practices that have quickly taken to EHRs over the past few years, saw a hefty number of malpractice suits related to failures in physician examinations, symptom evaluation, poor record keeping, a lack of follow-up and care coordination, and mistakes in diagnostic testing.
“Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims,” Schiff writes.
Instituting better safeguards in these problem areas can help eliminate many of these lawsuits, Schiff advises, but at the same time, more electronic documentation could make it more difficult for physicians to defend themselves against patient claims. With everything from log in locations to keystrokes tracked and stored by EHRs, physicians may have a harder time explaining themselves, especially if they turned off those pesky alerts or only glanced at a default template before saving it.
That could end up driving more careful behavior on the part of clinicians, but any positive effects may take a long time to show themselves. It typically takes several years for an incident to turn into a lawsuit, and collecting data on these events is a long-term investment. However, as providers deepen their experience with EHRs, awareness is growing about the all-too-easy slip of the key that can send a patient into cardiac arrest. While occasional software glitches may be inevitable, providers know that it’s in their best interests to keep tabs on their EHRs to avoid causing harm to their patients and their wallets.source
