The Doctors Company, the largest physician-owned medical malpractice insurance company in the United States, recently issued an updated study regarding it closed claims medical malpractice experience in which electronic health records (EHR) were involved. The Doctors Company stated, “we’ve seen the number of closed claims in which EHRs were a contributing factor increase continuously over the past 10 years. While EHRs have brought many positives, they have also created new risks and frustrations for doctors and patients.”
The Executive Summary to the updated study stated, “In our study of 66 EHR-related claims from July 2014 through December 2016, we found that 50 percent of these claims were caused by system factors such as failure of drug or clinical decision support alerts and 58 percent of claims were caused by user factors such as copying and pasting progress notes.”
The Key Findings of the updated study regarding The Doctors Company’s closed medical malpractice claims are as follows:
– The pace of EHR-related claims has grown over the past 10 years, from a low of 2 cases in 2007 to 2010 to 66 cases from July 2014 to December 2016;
– From mid-2014 to 2016 there was an increase in EHR-related claim events occurring in patient rooms and fewer occurring in hospital clinics/doctors’ offices, ambulatory/day surgery centers, labor and delivery, and ERs;
– Diagnosis-related allegations were the most common, increasing to 32 percent of all allegations, up from 27 percent in the earlier study.
Currently, EHR are used in 80% of physician office practices and in 90% of hospitals. The Doctors Company states in its updated study report, “Many EHR-related problems could have been avoided if the federal government had developed vendor standards for EHR use and interoperability and required beta testing in the healthcare environment to ensure usability and safety before the HITECH Act mandated its widespread adoption in 2009. However, the impetus for the rapid implementation of EHR use was to enable the transition from a volume-based (fee-for-service) payment system to an outcome-based (pay-for-performance) payment system—not to optimize productivity, workflow, and communication. Physicians and other healthcare workers played a minimal role in the initial design of the EHR, and their subsequent workplace experience and concerns have been largely ignored. Optimization of the EHR beyond the current model (digitization of the written medical record) will likely take many years and involve redesigning workflow, creating standardized protocols, using artificial intelligence, and applying big data techniques to healthcare, etc.”
The Doctors Company’s updated study found that “the EHR is a contributing factor in a medical malpractice claim rather than its primary cause … user factors (conversion issues, discrepancy between free text and templates, copy-and-paste issues, data entry errors, alert issues, user fatigue, workarounds, etc.) contributed to 58 percent of EHR-related claims and system factors (systems technology and design issues, data routing problems, inappropriate drop-down menu responses, failure of alerts, alarms, and clinical decision support [CDS], etc.) contributed to 50 percent. Some claims contain both system and user factors.”
The updated study results differed from the original study as follows: “more EHR-related claim events occurred in patient rooms and fewer occurred in hospital clinics/doctors’ offices, ambulatory/day surgery centers, labor and delivery, and ERs. Overall, with regard to the medical specialties involved in these events, internal medicine, hospital medicine, and cardiology showed marked decreases. Family medicine and nursing also showed decreases, while orthopedics, emergency medicine, and obstetrics/gynecology showed increases.”
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