Imagine this scenario: Your patient's PSA levels have gone up slightly since the last time you saw him, so you decide to repeat the test in three months. At that time, the levels haven't changed, so you write an order to test again in six months.
Then a year goes by, and your patient is finally tested again and diagnosed with prostate cancer. He tries to sue you, claiming negligence for not testing more frequently.
In this case, accounted by James Gottesman, an urologist who founded a company that developed automated informed-consent tools, the physician was off the hook, as he had documented his reasoning in his EHR each step of the way.
A claim of negligence can often be nipped by good documentation, made easier and more consistent through the templates in the EHR, says Gottesman.
Using an EHR may also reduce paid malpractice settlements for physicians, according to a 2008 study in the Archives of Internal Medicine. The study found that 6.1 percent of physicians with EHRs had paid malpractice settlements in the preceding 10 years, compared with 10.8 percent of physicians without EHRs. More significantly, among the EHR users, 5.7 percent of the more active users paid settlements, compared with 12.1 percent of less active users.
"The use of EHRs may lead to fewer diagnostic errors, improved follow-up of abnormal test results, better guideline adherence, and fewer adverse clinical elements," the study authors wrote. "Alternatively, EHRs may be facilitating more extensive and more legible documentation of medical practice, resulting in stronger legal defenses when malpractice suits are filed."
Of course, EHR use won't be a panacea to malpractice woes, and it's not entirely clear yet if the technology shift will help bring down malpractice premiums or reduce claims. But experts agree that when used correctly, an EHR can help ease your risk.
"The EHR is a tool. It depends on how the tool is used," says Jeffrey Segal, a neurosurgeon and CEO and founder of Medical Justice Services Inc., based in Greensboro, N.C. "Not all EHRs are the same, and the ones docs love are the ones that can help the most."
Let's take a closer look at the ways an EHR can help, and the potential pitfalls that can expose your practice to increased risk.
How they can help
Steven Waldren, a family physician and director of the American Academy of Family Physicians' Center for Health IT, offers three areas in which a properly used EHR can help minimize malpractice risk:
Documentation. Solid, complete, and legible documentation can go a long way to protecting your practice. An EHR allows a practice to audit and track data entry, and ensure that information can't be changed or removed. Each move — and who makes it — is included in the record, and experts say documentation is one of the primary ways an EHR can help physicians avoid certain malpractice claims.
A computer system can also solve the problem of the physician's traditionally abysmal handwriting, says Elliot Menkowitz, an orthopedic surgeon and medical director of Doctors Advocate, which aims to protect healthcare professionals from frivolous lawsuits. "Doctors can't write legibly," he notes. "There have been many lawsuit cases that have occurred just because the prescription was misinterpreted by the pharmacists who couldn't read the doctor's writing." The EHR, however, is going to improve the handwriting, as well as the data entry, he says, by forcing the doctor to enter certain fields and document certain items that might have otherwise been overlooked.
Care-process automation. The EHR "doesn't allow things to slip through," Waldren explains. Templates and prompts ensure you will cover all the necessary points in the exam or procedure. For example, in most practices, a physician will be inclined to follow up on a case after receiving an abnormal lab result. But what happens if the physician never receives the lab results? "In an electronic system, those things can be tracked," Waldren says. The system can help track and demonstrate when procedures occurred, calls were made, and any action was taken — across the entire staff.
Decision-support tools. An EHR's decision-support tools, such as computerized alerts, clinical guidelines, and patient-specific information, can provide another safety net by improving patient care and avoiding error. An EHR can remind the physician of patient allergies, medications, and demonstrate that the physician followed certain guidelines, Waldren says.
How they won't help
Relying on an EHR to reduce your risk isn't without its hazards, however. In fact, EHR implementation can open your practice up to new risks if you're not careful, says consultant Ronald Sterling.