COMMENTARY

Your Malpractice Advisor: Malpractice Risks of e-prescribing

David B. Troxel, MD

Disclosures

March 23, 2012

Introduction

E-prescribing is being rapidly adopted in physician offices, driven by federal financial incentives. It is estimated that 35% of physician office practices now use e-prescribing.

In many ways, e-prescribing helps lessen malpractice risk. E-prescribing works with the electronic health record (EHR), which incorporates clinical decision support systems that provide alerts, warnings, and reminders for medication management. These include drug/drug interaction lists and alerts about improper drug dosages and drug allergies. The EHR also facilitates medication reconciliation, ensuring that the active medication list corresponds to what the patient is actually taking.

Although integrating an EHR into medical practices has great potential to advance the practice of medicine and patient safety, there are always unanticipated consequences when new technologies are adopted. The EHR is no exception. We're beginning to recognize real and potential liability risks, and it's important for physicians to become familiar with them.

New Risks for Doctors

Doctors are responsible for the clinical information that they have reasonable access to. Using an EHR increases access to electronic health data from outside the practice. Doctors may access it from the practice EHR or practice Website, or through a health information exchange (eg, hospital charts, consultant reports, and laboratory and radiology reports).

E-prescribing can also alert the physician to potential interactions between the drugs they prescribe and drugs prescribed by others, through community medication histories. For example, Dr. A renews a medication, and his e-prescribing program sends an alert advising him that the medication could interact with another drug that the patient is taking. He has not prescribed that drug, so his office staff will have to contact the patient to identify who has prescribed it, and then Dr. A will have to contact Dr. X to "negotiate" which drug will be discontinued or changed. If failure to take this action results in patient injury from a drug/drug interaction, the physician may be liable.

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