My last posting was about the "risky business" of EHR implementation. I noted that there were starting to be some rumblings from insurance carriers that were concerned that as EHR implementation grew, we'd likely start seeing more lawsuits related to improper selection, training, or some other aspect of use.
Thinking about the what-ifs
EHRs are such a huge topic right now — and are hanging over the heads of so many medical offices — that I think the topic warrants another look.
Amidst the urgency to implement EHR systems, we are all focused on ensuring that we should maintain quality of care and outcomes, while managing costs and keeping disruption to daily operations to a minimum. These are the "clear and present" priorities. But there is an important "what-if" to remember while selecting, implementing, and maintaining your EHR. What if there is a malpractice claim involving the EHR?
This could happen to you
For example, a patient is diagnosed with end-stage colon cancer and the family blames you for not finding the disease, and taking steps to avoid the now-terminal prognosis. A few months ago, your office received a note about this patient indicating that a suspicious spot was found following a colonoscopy. The specialist asked that someone in your office follow up with the patient to ensure that he went back to the specialist to have the area checked out. The nurse swears she put a note to that effect in the patient's chart. Someone else thinks they verbally told the patient something — but nowhere in the medical record is there a confirmation. At the same time that this happened, the office was moving from paper to electronic health records. Temporary employees were brought in to help with the process. The practice's guess is that someone lost the paper or didn't know that such a note was of vital importance. The office may never know what happened — they do know they now face a lawsuit, one that will be hard to defend because of lack of documentation, oversight, and seemingly simple mistakes.
Think like an attorney
Situations such as the one above are why I encourage physicians to think like attorneys whenever they launch a new process or system. Look at every phase of the decision-making process. Make sure that you as the physician are involved in any decision that could ultimately affect patient care. Recognize that attorneys will even potentially ask why one EHR system was purchased over another. If a system or technology was purchased because it was available at the lowest cost, that could be an issue if patient care is compromised. You need to document how you selected your EHR system to enhance patient care and maintain medical record integrity.
If you are in the process of implementing a new EHR system, think carefully about who will help you make the transition to electronic records. Now is not the time to hire a temp worker or a college student looking to make a few bucks. Qualified medical staff is key to transitioning your records safely to the EHR. If your transition was done "on the cheap," an attorney might suggest that you were negligent by hiring unqualified staff.
I also encourage physician offices to make sure they document all processes — from purchasing to training to implementation to ongoing staff education. This helps to highlight that appropriate steps were taken throughout the process, and frankly, could well avoid oversights such as the one in the above scenario.
Plaintiff attorneys have a job to do. They will research all aspects of a claim to identify areas that could have led to negligence. If you put yourself in their shoes and look at not only your EHR implementation, but the adoption of any new process or technology through their eyes, you will be better able to address and prevent problem areas — and much more importantly — help to improve the quality of care for your patients.
One last note: If you have concerns and need assistance, check with your malpractice insurer. Many offer free risk-management programs as a service within your policy, to help you minimize risk when it comes to EHR adoption and implementation.