EHRs are increasingly leading to malpractice lawsuits. While EHR-related lawsuits still make up only a small number of lawsuits, user error is the cause of 64 percent of EHR-related malpractice claims, according to the Doctors Company. Practices need to focus on eliminating several common problems, mostly tied to user actions, which have led to the majority of EHR-related suits.
Here are six EHR landmines physicians should avoid.
1. Copy and Paste
Many doctors are tempted to copy a note from a prior encounter and make changes as appropriate. This leads to a few potential problems. Sometimes physicians forget to update the note with the appropriate changes when copying and pasting, says David Troxel, MD, medical director and secretary of the Doctor’s Company board of governors.
2. Drop-down menus
Drop-down menus can often be the source of a user error that leads to a malpractice suit. Not only can users click the wrong thing in the menu, such as the wrong patient symptom, but these menus lead to structured information that physicians can easily overlook when reviewing a note.
3. Use of templates
Jeffrey Kagan, MD, a Newington, Ct.-based internist, has experience reviewing malpractice cases for attorneys. One trend he has seen related to EHR-induced malpractice suits comes from template use. "Templates are supposed to help us do something more comprehensive, but often our templates have a lot of old information that carries forward,” he says.
In order to avoid falling into this trap, Kagan advises physicians to proofread and modify templates if they are going to be used.
4. Alert Fatigue
The e-prescribing module in an EHR is a potential landmine for malpractice. Alerts indicating when there is a problem with medication dosage or drug-drug interaction will pop up as practitioners are inputting data into the EHR. As a result, doctors get annoyed and develop alert fatigue, and they just turn the alerts off.
While this is understandable, turning off the alerts could mean a potential significant problem could go undetected.
5. Clinical Decision Support Alerts
Another prompt that goes ignored, often to the determinant of the patient and the doctor, are clinical decision support (CDS) alerts. These are clinically relevant educational materials that come up as the practitioner is documenting in the EHR. Practitioners should ignore these at their own peril, Troxel says. If anything, physicians should document the reason why they overrode the CDS alert.
6. Missing Information
The idea of physicians missing a vital piece of information in the EHR can be either a user or a technical error. These types of problems are most likely to crop up when a physician is using a new system.
