The Risks Of Electronic Health Record Documentation Errors

image-EHR Systems written on chalkboard

The Risks of Electronic Health Record Documentation Errors

With the exponential growth of Electronic Health Care Records (EHRs) in healthcare, several risks associated with patient treatment and outcomes have cropped up. Amplified medical errors that can be tracked to the
application of EHRs is progressively the central theme in health-related malpractice cases.

Many lawyers, physicians, and IT professionals occupied in the legal process are concerned that data integrity glitches and privacy breaches could weaken the benefits of EHRs, unless the Federal government intervenes.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Keywords

Electronic Health Record, Documentation Error, Liability, Cardiologist, Licensed Physician,
Expert Witness, Malpractice, Adverse Event.

At a glance

Intro:

With the implementation of any new technology involving computer software such as EHRs, there is a risk-benefit ratio for patients and providers of healthcare services.

How and when do patients know if the information entered into an EHR is accurate?

Can healthcare providers guarantee the quality and safety of an EHR system that may have been compromised by documentation errors?

What recourse do patients have if they experience a medical adverse event propagated from ambiguous data entered into an EHR system?

Discussion:

  • Health Care Expenditure Trends
  • Medical Errors in Electronic Health Records
  • Types of Electronic Health Record Errors
  • Examples of Electronic Health Record Errors

Conclusion: Adverse events correlated with EHR susceptibilities can trigger widespread injury and are faced through the gamut of health care venues and collective technological parameters.

The documented EHR malpractice suits deliver constructive examples that both licensed physicians and software designers could embrace to diminish the threat of injury in the years
forthcoming.5

Healthcare Expenditure Trends

National health expenditures in the United States were about $3.6 trillion in 2018 and are projected to reach nearly $6.0 trillion by 2027, with annual increases averaging about 5.5
percent.3

 

“Reports indicate that medical malpractice-related costs are almost $60 billion, or between 2% to 3% of annual healthcare spending. This total does not include all the medical
costs incurred from defensive medicine, such as unwarranted tests and treatments to avoid
lawsuits.”1

 

With such large amounts of capital being spent each year, efficiencies over the past two decades have been explored and enacted by the Federal government.

 

For example, health care in the past 13 years has faced a changeover from paper charts to electronic health record (EHR) systems.

 

The Federal Health IT Strategic Plan and monetary enticements offered through the ARRA/HITECH Act in 2009,2 allowed 96% of qualified hospitals and 80% of physician offices in 2017, to embrace certified EHR software.3

 

With the exponential growth of EHRs in healthcare, several risks associated with patient treatment and outcomes have cropped up. Amplified medical errors that can be traced to the
application of EHRs are progressively the central theme in health-related malpractice cases.

Many lawyers, physicians, and IT professionals occupied in the legal process are concerned that data integrity glitches and privacy breaches could weaken the benefits of EHRs unless the Federal government intervenes.4

 

According to The Doctors Company, EHRs issues comprised
around 1% of the medical malpractice suits in the United States between 2007 and 2013.4 This statistic can be misleading as many of these malpractice cases take 5-6 years to litigate, and the number of EHR cases doubled between 2013-2014.4

 

With the implementation of any new technology involving computer software such as EHRs, there is a risk-benefit ratio for patients and providers of healthcare services.

  • How and when do patients know if the information entered into an EHR is accurate?
  • Can healthcare providers guarantee the quality and safety of an EHR system that may have been compromised by documentation errors?
  • What recourse do patients have if they experience a medical adverse event propagated from ambiguous data entered into an EHR system?

Types of Electronic Health Record Errors

The medical-legal cases involving EHRs, assert a comprehensive variety of inaccuracies and data gaps. Namely, physician dependence on updated or erroneous records; speech recognition software that cuts crucial words; a misreading of drop-down menus which causes erroneous quantities of medication to be administered to patients, and misspelled words that cascade to medication mistakes.4

 

Incongruities can occur amongst what physicians and health
care personnel view on a computer display and the paper copies of EHRs given to patients. The scenario lends various judges and juries to doubt the testimony of health care personnel and can grant the plaintiff huge award settlements.4

 

A convoluted relationship between an EHR system and health procedures triggers numerous complications. EHR safety problems are habitually misdiagnosed, thus perpetuating an
avenue of under or overdose of treatment regimens.

 

To illustrate, the copy-and-paste keyboard option of EHRs enables physicians to input data without little thought and attention, but that can spearhead blunders and mayhem.

 

If an audit occurs, and there are cloned records in different
patient charts, the health care provider or treating physician is going to have a difficult time defending themselves in a court of law.4

 

Some doctors are expert witnesses who are available to testify in a court of law on behalf of patients who have experienced a serious medical adverse event. These physicians include
cardiologists who know how serious a misdiagnosis, medication error, mishandled triage of care, or incorrect treatment can impact a patient and their family.

 

The law firms representing a hospital or physician practitioner may try to downplay an EHR error or even suggest that the
patient misunderstood the information conveyed to them.

 

The subject matter experts are licensed physicians who can offer credible, concrete, and concise testimony to a judge or jury in a medical practice lawsuit. Their experience, skills, and education enable specialists such as cardiologists to separate fact from fiction, and they have to ability to defend whether an EHR documentation error has occurred and how it has impacted the patient and their treatment outcomes.

Examples of Electronic Health Record Errors

Electronic Health Record associated issues contain a broad variety of malpractice cases that entail technology and software design problems that negatively influence patient diagnosis and treatment:5

  • “A patient complained of ‘sudden onset of chest pains with burning epigastric pain, some relief with antacid’; because the ‘complaint' field in the EHR was too small, the entry was noted only as ‘epigastric pain’; no electrocardiogram was done and the patient experienced a cardiac event days later.”5

 

  • “Researchers identified which specialties receive the highest percentage of claims where EHRs are a factor. Family medicine and internal medicine were in the lead, at eight percent, followed closely by radiology and cardiology at six percent.”6

 

  • “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. Five days later, the patient expired from 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.”7

 

Inferior and absent myocardial infarction (MI) EHR documentation is one of the most frequent and pricey causes for emergency room malpractice claims.8,9

 

Precise EHR documentation is critical in any misconduct situation, but particularly for impacted MI patient cases.10

 

The EHR ought to incorporate a detailed report of the diagnostic signs, patient history, and prospective non-MI sources of the symptoms.10

 

Simply recording ‘chest pain’ in the EHR is often debatable as it permits wiggle room afterward to contend that the discomfort hinted at was a myocardial infarction. When the proper facts are logged in the EHR system, the litigant cannot exaggerate or alter the nature of the disease once the lawsuit has commenced.10

Electronic Health Records Conclusion

There is extensive harmony that the highest capability of EHR technology has not yet been fully recognized. Some instances of specific apprehension are the inadvertent consequences of EHRs that take away from the quality of health care or from the utilization of EHRs itself.5

 

Adverse events correlated with EHR susceptibilities can trigger widespread injury and are faced through the gamut of health care venues and collective technological parameters. The documented EHR malpractice suits deliver constructive examples that both licensed physicians and software designers could embrace to diminish the threat of injury in the years forthcoming.5

 

There are licensed cardiologists who can testify in litigation cases who can furnish an expert opinion to support the patients and their families or the hospital system. These malpractice cases have a huge impact on patients, physicians, and hospital groups.

 

As more uptake and training occurs for EHR systems, and as design changes and artificial intelligence tools are added, the
frequency of litigation cases may dissipate and hopefully shift to do no harm for most patients.

 

EHR systems are a vital component in the future of documentation for cardiac patients who face uncertainty in times of medical intervention, but people and organizations must be held accountable for erroneous actions leading to adverse medical events.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Do you have questions about a medical case or need help understanding treatment plans and options?

Cardio Med Legal Dr. Jasdeep Dalawari

(804) 500-0685 - info@cardiomedlegal.com

References

1. Bono MJ, Wermuth HR, Hipskind JE. Medical Malpractice. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2021 Jan. https://www.ncbi.nlm.nih.gov/books/NBK470573/
2. Office of the National Coordinator for Health Information Technology. Federal Health IT
Strategic Plan 2015–2020. http://www.healthit.gov/policy-researchers-implementers/health-itstrategic-
planning. Published 2014.
3. Office of the National Coordinator for Health Information Technology. Federal Health IT
Strategic Plan 2020-2025.
https://www.healthit.gov/sites/default/files/page/2020-
10/Federal%20Health%20IT%20Strategic%20Plan_2020_2025.pdf. Published Oct 2020.
4. Allen J. Electronic record errors growing issue in lawsuits. Politico website.
https://www.politico.com/story/2015/05/electronic-record-errors-growing-issue-in-lawsuits-
117591. Published May 4, 2015.
5. Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic health record–related events
in medical malpractice claims. Journal of Patient Safety. 2019;15(2):77-85.
https://doi.org/10.1097/PTS.0000000000000240
6. Kent J. EHR-related claims still prevalent in medical malpractice suits. EHR Intelligence
website. https://ehrintelligence.com/news/ehr-related-claims-still-prevalent-in-medicalmalpractice-
suits. Published August 28, 2019.
7. Ranum D. Electronic health records continue to lead to medical malpractice suits. The Doctors
Company website. https://www.thedoctors.com/articles/electronic-health-records-continue-tolead-
to-medical-malpractice-suits/. Published August 2019.
8. Ferguson B, Geralds J, Petrey J, Huecker M. Malpractice in emergency medicine — a review of risk and mitigation practices for the emergency medicine provider. J Emerg Med. 2018;55:659-665.
9. Brown TW, McCarthy ML, Kelen GD, Levy F. An epidemiologic study of closed emergency department malpractice claims in a national database of physician malpractice insurers. Acad Emerg Med. 2010;17:553-560.
10. Documentation Can Determine Outcome of Missed Myocardial Infarction Lawsuit. Relias
Media Website. https://www.reliasmedia.com/articles/147577-documentation-can-determineoutcome-
of-missed-mi-lawsuit. Published March 1, 2021.

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.