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EMRs Can Create New Malpractice Problems

In theory, EMRs have the capacity to improve patient care and avoid medical errors, but they also stand the chance of creating errors of their own, so users shouldn’t expect EMRs to lower their malpractice premiums, according to a story reported in FierceEMR.

In fact, the story suggests, EMRs can create new problems and make it harder to defend against lawsuits arising from some EMR-related problems, including the following, FierceEMR notes:

  • Disabled clinical decision support alerts that, if used, could have caught a problem
  • Auto complete functions that fill in data incorrectly
  • Sharing of passwords, so that physicians look like they’re viewing the chart when they really aren’t or in more than one place at the same time
  • Sloppy documentation, such as data entered incorrectly

What’s more, EMRs create audit trails which make it easier for plaintiff’s attorneys to find errors in care. And on top of that, legal costs for “e-discovery” — the collection of evidence from electronic systems — can raise the expense of a legal battle further, FierceEMR says.

Here’s an example of a situation in which an EMR-based error can create serious legal exposure. In one case lodged against the  University of Pittsburgh Medical Center, a 62-year old man died due to otherwise treatable bleeding in the brain because an intubation failed.

UPMC’s policy is that when a patient is a difficult intubation case, that must be noted directly in the EMR, which then displays a bright yellow banner nothing the problems at the top of the record. However, “difficult intubation” was not noted in his chart.  When his breathing tubes were later removed, he could not continue to breathe on his own. Attempts to re-intubate him failed, and he died.

As if that wasn’t bad enough, the defense alleges that after the patient’s death, a QA official from UPMC accessed the system and retroactively entered data labeling the deceased as a difficult intubaton. When that didn’t create the yellow banner, the defense claims, the official retracted the “diff intub” entry. Unfortunately for him, all of his actions were logged by the system.

The bottom line is that as it becomes apparent that EMRs come with their own set of safety issues, malpractice insurers who once offered premium discounts to those who use EMRs are dropping the idea. EMRs certainly have the potential to offer improved safety in some instances, but human error isn’t going away completely no matter what fixes EMRs offer.

October 9, 2013 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.

UPMC Sinks $100MM Into Big Data

The University of Pittsburgh Medical Center has announced plans to spend $100 million over five years to create a massive data warehouse, a move which puts it well at the forefront of hospital “big data” efforts.

According to Information Week, UPMC’s data warehouse will bring together clinical, financial, administrative, genomic  and other information. The health system has targeted more than 200 data sources across the Medical Center, UPMC Health Plan and other affiliates.

I’ll let Information Week describe the technical set-up:

To collect, store, manage, and analyze the information maintained in the data warehouse, UPMC will use the Oracle Exadata Database Machine, a high-performance database platform; IBM’s Cognos software for business intelligence and financial management; Informatica’s data integration platform; and dbMotion’s SOA-based interoperability platform that integrates patient records from healthcare organizations and health information exchanges. These tools will manage the 3.2 petabytes of data that flows across UPMC’s business divisions.

As to how UPMC plans to use these tools, they’re hoping to do all of the things you might imagine, including genomically-tailored prescribing, population analytics and sophisticated tracking of individual patient data to make predictions about possible risks.

As I see it, UPMC’s efforts highlight both the importance of big data efforts and the downside in making the investment.

On the one hand, you’ve got the benefits. For example, patients will clearly see better outcomes if doctors can use top-drawer analytical tools to predict how treatments will work or know well in advance if a patient’s condition is about to go south.  And hospitals will clearly run better if execs get insights into issues that cross clinical and administrative boundaries, such as ED or OR utilization.

On the other, you’ve got the reality that big data projects are prohibitively expensive for all but the best-funded of healthcare organizations, and probably won’t produce returns on investment for several years at best.  Average community hospitals won’t be consolidating and analyzing their data this way anytime soon.

November 6, 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.

UPMC Kicks Off Competitive HIE

The University of Pittsburgh Medical Center has kicked off a new HIE connecting its properties with other health systems in western Pennsylvania.  The project, which should bring together access to more than 7 million patient records, goes into direct competition with that being launched by major state health insurer Highmark Inc.

UPMC’s HIE, ClinicalConnect, brings together its facilities with clinicians at Butler Health System, Heritage Valley Health System, Altoona Regional Health System, Armstrong County Memorial Hospital, Excela Health, Jefferson Regional Medical Center, St. Claire Hospital and Washington Hospital. While reports don’t describe how ClinicalConnect is being funded, you’ve gotta believe the $9 billion UPMC is fronting a lot of cash.

This move sets up an interesting competitive situation on the state, a fairly unusual one given that it’s built around an HIE.

Right now, UPMC is the 2,000 pound gorilla of western PA. Meanwhile, $14.6 billion Highmark is one of the dominant health insurers in the state. And now they’re going head to head on the HIE front. Mean ol’ Highmark has publicly announced its intention to build a system with UPMC’s bitter rival West Penn Allegheny Health, and as part of its plans, expects to launch a statewide HIE that could conceivably bypass UPMC’s regional effort.

When asked by a reporter whether the two HIEs can work together, their spokespeople basically said “Humph!” and denied that anyone cared about competition.  Oh yeah, we definitely believe that.

What interests me about this hoo-haw is that it both organizations seem to see their HIE as critical to their delivery network development efforts. While it makes perfect sense, it hasn’t been a big theme in HIE discussions to date. (My sense is that most hospital CIOs have seen HIEs as plumbing rather than a value-add.)

Interesting stuff here. I’m eager to see what happens next.

July 5, 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.