User error, such as incorrect data input, contributes to the majority of medical malpractice claims that involve electronic health records.
Of 97 EHR-related malpractice claims that closed from January 2007 to June 2014, 64% involved user errors, while 42% related to system factors, according to an analysis from national medical liability insurer The Doctors Company. (Numbers do not add up to 100% because some claims contained more than one contributing factor.)
The most common user errors included incorrect information in the EHR (16%), hybrid health records/EHR conversion (15%), and problems regarding prepopulating/copy and pasting (13%). Less common user factors involved training/education, EHR alert issue or fatigue, and workarounds, according to the report.
EHR-related malpractice claims appear to be on the rise, said Dr. David B. Troxel, medical director for The Doctors Company. Of the 97 EHR-related claims, 26 claims closed in the first half of 2014, compared with 28 claims that closed in 2013, 22 that closed in 2012, 19 that closed in 2011, and 2 that closed between 2007 and 2010.
“Electronic health records provide benefits but also create risks that can contribute to medical malpractice claims,” Dr. Troxel said in an interview. “Their widespread use is too recent to tell whether the benefits will outweigh the risks and result in a decrease in adverse patient events. In the meantime, I believe we will see an increase in claims over the next few years in which EHRs are a contributing factor.”
Of system-related EHR claims, 10% involved system design failures. Electronic systems/technology failures contributed to 9% of cases, and 7% involved a lack of EHR alert or alarm/decision support. Other system-related claims were attributed to inappropriate data routing, insufficient scope/area for documentation, and fragmentation.
In one such case examined, a plaintiff claimed the lack of a medication risk alert led to the death of a dialysis patient. The patient was transferred to a skilled nursing facility with an active hospital transfer order for enoxaparin. A physician evaluated the patient upon admission but made no comment about the enoxaparin order. During the first dialysis treatment, there was active bleeding at the fistula site, but a nurse did not inform the physician. During the second dialysis treatment, there was uncontrolled bleeding from the fistula, and the patient later died.
As for practice area, internal medicine subspecialists – including cardiologists, hospitalists, oncologists, and gastroenterologists – were the most likely to see EHR-related claims at 20%. Primary care physicians – family physicians and general internists – faced claims in 16% of cases, while ob.gyns. were accused in 15% of cases. Other cases involved claims against surgeons (14%), nurses (7%), radiologists (5%), anesthesiologists, (4%), general surgeons (4%), pediatricians (2%), emergency medicine physicians (2%), psychiatrists (2%), orthopedists (2%), and pathologists (1%). Other claims were against nonphysician providers.
Among all EHR-related claims, the top allegations made were diagnosis failure and medication error, including allegedly ordering the wrong medication, prescribing an incorrect dosage, or improper medication management.