The Evolving Landscape of Medical Malpractice in the Era of Electronic Health Records

From Paper to Pixels: Examining Malpractice Trends Before and After EHR Implementation

Medical errors have long been a leading cause of preventable patient harm, often resulting in malpractice lawsuits against healthcare providers. With the healthcare industry’s widespread adoption of electronic health records (EHRs) over the past decade, the landscape of medical malpractice has fundamentally changed.

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Defining Medical Malpractice

Medical malpractice occurs when a healthcare provider deviates from the accepted standard of care and causes harm to a patient. This can include errors like surgical mistakes, misdiagnoses, medication errors, and inadequate patient monitoring. When such errors result in significant harm or death, aggrieved patients may file medical malpractice lawsuits seeking compensation.

As healthcare delivery grows more complex and reliant on technology, EHR systems have become central to provider workflow and patient care coordination. But how exactly has the transition to EHRs impacted medical malpractice trends in recent years?

According to Dr. Hardik Soni, CEO and Founder of Calysta EMR, “While EHRs have tremendous potential to enhance patient care and reduce certain errors, they also introduce new challenges that affect malpractice risk." Throughout this article, we will explore Dr. Soni's insights on this evolving landscape.

Malpractice in the Pre-EHR Era

Prior to the widespread use of EHRs, paper medical records were the norm in most healthcare organizations. With scattered paper charts and documents, providers often struggled to access complete medical histories and coordinate care effectively across multidisciplinary teams.

Some of the most common causes of malpractice events in the pre-EHR era involved poor documentation, miscommunication during handoffs, and diagnostic errors due to incomplete information. Disorganized paper records made it difficult for doctors to detect abnormal test results or dangerous medication interactions.

“Illegible handwriting in paper records frequently contributed to medication dosing errors and other issues,” notes Dr. Soni. “And the lack of clinical decision support in paper charts increased the risk of diagnostic errors and inappropriate treatment plans.”

The Transition to Electronic Health Records

The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 catalyzed rapid EHR adoption across US healthcare organizations through financial incentives. By 2015, over 80% of hospitals and half of office-based physicians had implemented certified EHR systems.

This transformative shift held great promise to enhance clinical care and reduce medical errors. However, the transition was not without challenges. Many providers struggled with suboptimal system design, productivity losses from learning new EHR workflows, and added documentation burdens that detracted from patient care.

Malpractice Trends in the EHR Era

While EHRs were intended to reduce medical errors, some aspects of electronic documentation have created new avenues for mistakes.

Flawed system interfaces, auto-populated data, and copy-paste functions can contribute to inaccurate or outdated information in patient records. Information overload from extraneous copy-pasted data can make it harder for doctors to discern the most pertinent clinical details.

“We’ve seen issues with wrong patient selection in EHRs, corrupted data from system migrations, and critical diagnostic test results getting buried in the electronic inbox,” notes Dr. Soni. “These emerging EHR-related errors are reflected in malpractice cases.”

Recent studies have explored the relationship between EHR adoption and malpractice claims. While findings are mixed, one major study found a modest initial rise in malpractice claims against physicians after EHR implementation. This highlights a period of increased liability risk during the learning curve phase of EHR adoption.

Why EHR Adoption Can Increase Malpractice Risk

Several factors contribute to increased malpractice exposure when organizations first implement EHR systems:

• User errors - Insufficient EHR training can lead to improper documentation or incorrect use of EHR functionality.
• System glitches - Even certified EHR products have software defects that lead to data errors or missing information.
• Interoperability gaps - Fragmented systems with limited interoperability can impede access to patient data from external organizations. This fragmentation can contribute to delayed diagnoses.
• Alert fatigue - Doctors overloaded with EHR alerts and notifications can become desensitized to critical warnings.

Dr. Soni suggests, “Organizations need ongoing EHR safety assessments to identify and mitigate emerging safety risks and liability concerns.”

EMR and Medical Malpractice Risks

Beyond EHR challenges, let’s explore how a provider’s core EMR (electronic medical record) software impacts malpractice exposure.

Flawed EMR system design, such as fragmented user interfaces, can increase the likelihood of data entry errors and information gaps in patient charts.

Some EMR solutions lack clinical decision support tools to alert doctors to dangerous medication combinations or prompt evidence-based care protocols. Missing CDS functionality can contribute to faulty clinical judgment and medical errors that lead to malpractice suits.

Conversely, a thoughtfully designed EMR system can help reduce malpractice risks in several ways:

• Integration of prescription databases to check for harmful drug interactions
• Clinical alerts and reminders that guide best practice treatment protocols
• Clinical documentation tools that prompt doctors to capture complete patient histories
• Data validation checks that prevent erroneous data from being saved into patient records

“An optimally designed EMR system minimizes opportunities for user error while facilitating clinical precision,” says Dr. Soni. “This is central to our approach in developing Calysta EMR.”

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Mitigating Physicians’ Malpractice Risks with EMR

For physicians, improperly maintaining EMRs can increase malpractice exposure. But thoughtfully leveraging EMR capabilities can also help physicians defend against malpractice claims.

• Thorough EMR documentation - Comprehensive notes on patient history, clinical decision-making rationale, and test/lab results provide crucial evidence of responsible care.
• Diligent record review - Carefully reviewing EMR data from prior encounters helps physicians avoid diagnostic oversights.
• Clinical decision support - Following CDS alerts and reminders demonstrates adherence to clinical guidelines.
• Data validation - Double checking EMR data entry helps prevent harmful medication or treatment errors.

In Closing

The healthcare industry’s transition to EHRs and EMRs has profoundly impacted medical malpractice trends and risks. While digital records show immense potential to enhance care coordination and reduce certain errors, new technology-related safety gaps have also emerged.

By implementing patient safety protocols tailored to modern EHR systems, healthcare organizations can realize the benefits of health IT while minimizing risks and malpractice liability. As medical technologies and clinical workflows continue to evolve, proactive safety efforts to prevent errors and harm will become increasingly imperative.

Calysta EMR aims to support providers through this journey with user-centered EMR solutions that reduce everyday friction and enhance patient care. As Dr. Hardik Soni concludes, “With careful EMR implementation and ongoing optimization, we can leverage these tools to drive better health outcomes across our healthcare system.”

Understanding the Implications of EHRs on Medical Malpractice: Frequently Asked Questions

How Has the Adoption of EHRs Changed Medical Malpractice Trends?

EHRs have both reduced certain types of errors and introduced new challenges affecting malpractice risk. The transition to EHRs has been associated with a shift in the nature of malpractice claims, reflecting both the benefits and the emerging risks of digital health records.

What Were Common Causes of Malpractice in the Pre-EHR Era?

Before EHRs, malpractice often stemmed from poor documentation, miscommunication during patient handoffs, and diagnostic errors due to incomplete information, largely due to disorganized paper records.

How Can EHR Adoption Increase Malpractice Risk?

Early phases of EHR adoption can increase malpractice exposure due to user errors, system glitches, interoperability gaps, and alert fatigue. These issues can lead to documentation inaccuracies and delayed or incorrect diagnoses.

What Ongoing Efforts are Needed to Minimize EHR-Related Malpractice Risks?

Continuous safety assessments of EHR systems are essential to identify and mitigate emerging safety risks and liability concerns. This involves both addressing technological issues and enhancing user training and support.

How has patient access to their own EHRs influenced medical malpractice claims?

Patient access to EHRs, facilitated by patient portals, has significantly impacted malpractice claims.

This transparency allows patients to review their medical records, leading to increased patient engagement and awareness.

However, it also means that patients are more likely to identify potential errors, which could lead to an increase in malpractice claims if discrepancies or mistakes are found in their records.

What role do EHR audits play in malpractice litigation?

EHR audits play a critical role in malpractice litigation by providing a detailed log of all interactions with a patient's electronic health record.

This includes information about who accessed the record, what changes were made, and when these activities occurred.

Audit trails can be crucial in legal settings to establish timelines, verify adherence to protocols, and demonstrate the thoroughness of care provided.

Can the use of EHRs impact the outcome of a malpractice lawsuit?

Yes, the use of EHRs can significantly impact the outcome of a malpractice lawsuit. Comprehensive and accurate EHR documentation can provide strong evidence of proper care and adherence to protocols.

Conversely, inconsistencies or errors in EHRs can be used to challenge the quality of care provided. In some cases, EHRs have been pivotal in proving or disproving allegations of negligence.

How do EHRs influence communication among healthcare providers and its effect on malpractice risks?

EHRs have transformed communication among healthcare providers by enabling more streamlined and accessible sharing of patient information.

This improved communication can reduce errors due to miscommunication, a common issue in the pre-EHR era.

However, if not used properly, EHRs can also lead to information overload or misinterpretation of shared data, potentially increasing malpractice risks.

Are there specific training programs for healthcare professionals to reduce EHR-related malpractice risks?

Yes, there are specific training programs designed to educate healthcare professionals on the effective and safe use of EHR systems.

These programs focus on accurate data entry, understanding EHR functionalities, recognizing and responding to system alerts, and maintaining compliance with legal and regulatory standards.

Training is important for minimizing user-related errors and enhancing the overall safety and efficiency of EHR use.

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