Mitigate Malpractice Mistakes: 3 Risks Associated With EHR Implementation

By: on April 25, 2019

In 2017, about $3.9 billion was paid out to victims of medical malpractice, and payments for claims made in 2018 are expected to reach as high as $4 billion by the time they’re all settled. What’s more interesting is the fact that claims related to electronic health records have been steadily increasing over the years.

ehr related claims since 2007

Source: The Doctors Company

Small practices are not at all immune from these types of expensive lawsuits, and, thanks to a variety of potential HIPAA violations, there’s a real danger of making mistakes that can lead to lawsuits while using new and unfamiliar EHRs.

For that reason, it’s crucial to be aware of common EHR user errors that leave small practices vulnerable to malpractice lawsuits as well as how to avoid them.

To that end, we’ll use case studies from a report by The Doctors Company to explore the three most common EHR user-based causes of medical malpractice claims so you can prepare for and prevent those risks associated with EHR implementation.

1. Copy and Paste Are Not Your Friends


Case Study


A 35-year-old obese male presented to the insured for medical clearance. An ECG showed normal sinus rhythm, normal chest x-ray, heart rate 78, and BP 124/78. Three months later, he returned to the office complaining of chest pain, shortness of breath, and dizziness. His BP was 112/90 and pulse 106. Five days later, he died from pulmonary embolism due to deep venous thrombosis.

Defense experts questioned whether the physician had done a complete assessment, because the progress note from the most recent visit appeared identical to the prior visit’s progress note—including the same spelling errors—suggesting that the note had been copied and pasted.

Let’s give the benefit of the doubt here and assume the progress notes were just copied and pasted in an effort to save time. Even then, you can see the problem.

EHRs are designed to make things quicker, so the templates, workflows and automated processes that come with those systems are what you should think of as useful shortcuts—that’s it. Adding more shortcuts like copying and pasting increases your risk of overlooking things and making mistakes.

What did we learn? That EHRs have built-in shortcuts you can trust that should be used instead of manual shortcuts like copying and pasting. You owe it to your patients to give every visit your full attention, and that means taking the time to document changes in their progress.

2. Automation Is Awesome, but You Still Have to Double Check Everything


Case Study


A patient was seen by her physician for pain management with trigger-point injections of opioids. The physician ordered morphine sulfate (MS) 15 mg every eight hours. In the EHR, the drop-down menu offered MS 15 mg followed by MS 200 mg. The physician inadvertently selected MS 200 mg and did not recheck before completing the order. The patient filled the prescription, took one MS along with Xanax, and developed slurred speech—resulting in an ER visit with overnight observation.

I’m betting this one sounds a bit familiar to some of you, and that’s entirely understandable. There are loads of drop-down menus within EHR templates, and while they’re all designed to make things faster and easier, they don’t always do that.

It’s really, really easy to accidentally select the wrong option. Thankfully, features such as decision support can help highlight these mistakes before they become an issue by popping warnings when an incongruous selection is made.

Unfortunately, AI doesn’t always catch every mistake. That means you must double check everything before finalizing orders.

What did we learn? That automated drop-down menus can be really handy, but only if you double check your selections every time. Relying entirely on the EHR to do everything right is a dangerous game, and it puts your practice at risk.

3. When Implementing a New EHR, Train, Train, and Train Again


Case Study


A female presented to the ER with complaints of abdominal pain, nausea, and vomiting. An ovarian cyst had been removed two years prior. The emergency physician ordered an abdominal CT scan and called a gynecologist to evaluate the patient. The gynecologist reviewed a CT scan in the EHR that was later found to be the old scan showing the ovarian cyst. The patient was taken to surgery.

No cyst was found, and the patient developed a methicillin-resistant Staphylococcus aureus infection. The gynecologist had not been trained on the new system so did not find the new CT scan that was available.

The solution for this issue is a bit more involved than not using copy and paste and double checking your work because it requires a lot more work on the front end. The consequences of not properly training your team on your EHR are severe, though, so it’s better to put in that time right away to avoid dangerous mistakes like this one down the line.

Another thing to remember is that initial trainings throw a lot of new information at your team, and they’re likely to forget some of the things covered in those early sessions. Two things you can do to combat this are:

  1. Set up refresher courses periodically to go over some of the basics after your team has had time to be in the system and get familiar with it.
  2. Have quick resources readily available to your team. Post steps to specific processes around the office, send out FAQs and answers to everyone, and designate someone as the point person for questions that come up during the course of normal work.

What did we learn? Lack of training is the most critical user-based risk associated with implementing an EHR. If your team doesn’t know how to navigate even the most basic elements of your EHR, you’re at risk.

Choosing the Right EHR Matters

As costly as these simple mistakes can be, it’s good to know many of the risks associated with EHR implementation can be avoided by selecting the right system. For many small practices, that means finding an EHR with excellent customer service that will be as involved as you want them to be throughout the implementation process.

Reach out to our team of medical advisors to discuss your requirements and learn about EHRs that fit those needs exactly.

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