A total of 216 EHR-related medical malpractice claims closed between 2010 and 2018, according to a recent Doctors Company study.
Which Specialties Are Most at Risk?
In an effort to identify and communicate system failures that result in patient harm, The Doctors Company identified the specialties who receive the highest percentage of claims where EHRs are a factor.
EHRs typically remain contributing factors rather than the primary cause of claims, with 1.1 percent of all claims that have an EHR factor closed since 2010. However, the pace of claims in which EHRs contributed to injury is growing, from seven total cases in 2010 to an average 22.5 cases per year in 2017 and 2018, according to the report.
The EHR-related claims closed from 2010-18 were caused by system technology and design issues as well as user-related problems.
Here are the top technology and design issues cited by The Doctors Company, a physician-owned medical malpractice insurer.
· Other: 14 percent.
· EHR/technology failure: 12 percent.
· Lack of or failure of EHR alert or alarm: 7 percent.
· Fragmented record: 6 percent.
· Failure/lack of electronic routing data: 5 percent.
· Insufficient scope/area for documentation in EHR: 4 percent.
· Lack of integration/incompatible systems: 2 percent.
Which Specialties Are Most at Risk?
In an effort to identify and communicate system failures that result in patient harm, The Doctors Company identified the specialties who receive the highest percentage of claims where EHRs are a factor.
Top 12 Clinical Services with EHR Factors
Family medicine 8%
Internal medicine 8%
Cardiology 6%
Radiology 6%
Obstetrics 5%
Orthopedics 5%
Nursing 5%
Hospital medicine 4%
Gynecology 4%
Emergency medicine 3%
Anesthesiology 3%
Plastic surgery 3%
Urology surgery 3%
General surgery 3%
Case Examples: System Technology and Design Issues
Case 1: Electronic Systems/Technology Failure
Presentation: An elderly female patient presented to an otolaryngologist for sinus complaints. The physician intended to order Flonase nasal spray. The patient took the medication as directed. Two weeks later, the patient went to the ED for dizziness.
Outcome: The ED physician discovered the patient was taking Flomax—a medication for enlarged prostate, one side effect of which is hypotension. The original ordering physician had entered “FLO” in the medication order screen, and the EHR automatically selected Flomax. Not noticing the error, the physician selected it. There was no EHR drug alert for gender.
Case 2: Fragmented Record
Presentation: A 55-year-old male patient presented to the ED with back pain. He was diagnosed with severe lumbar stenosis. Following surgery, nurses noted neurological changes. They documented the changes and called the physician, but no action was taken.
Outcome: Due to a fragmented record (both paper and EHR), information was not communicated to the correct physician. The delay in contacting the correct physician resulted in a delay of return to surgery and partial paralysis.
Case Examples: User-Related Issues
Case 1: Copy and Paste
Presentation: A physical medicine physician followed a patient with extreme weakness due to cervical vascular malformation. Nurses and a physical therapist noted neurological changes, but the physician’s note indicated no changes. The physical therapist contacted the attending physician to discuss neurological changes including increased weakness. The physical therapist asked the physician to order a neurological consult due to the patient's deteriorating condition.
Outcome: The physician ordered the consult but did not explain why his documentation did not address the patient's changing condition. The patient was taken to surgery and now has incomplete quadriplegia. The physician was criticized for copying and pasting the same note for four days and delaying the intervention.
Case 2: Copy and Paste
Presentation: A 38-year-old obese patient presented for medical clearance. His test results were normal. Three months later, the patient presented with shortness of breath and dizziness. His blood pressure was 112/90 and pulse was 106. No tests were ordered.
Outcome: Five days later, the patient expired from a pulmonary embolism. Experts questioned whether the physician had conducted a complete assessment. The progress note was identical to the previous note from three months earlier, including old vital signs and spelling errors.
Case 3. The dangers of templates
To access the full report, click here.
EHR-related medical malpractice claims tripled since 2010, study finds: A total of 216 EHR-related medical malpractice claims closed between 2010 and 2018, according to a recent Doctors Company study.
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