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.