8 Malpractice Dangers in Your EHR

Neil Chesanow

Disclosures

August 26, 2014

In This Article

Ignore Clinical Decision Support at Your Peril

Clinical decision support (CDS) -- which includes drug/drug and drug-allergy alerts -- is an EHR's most annoying feature, as many doctors see it. They bridle at a computer telling them how to practice medicine, and the unending stream of alerts, many unnecessary, can be irritating.

As a result, many doctors click through CDS recommendations and alerts with barely a glance, override them, set higher thresholds that trigger alerts to reduce their number, or don't install the CDS module for their EHRs in the first place.

An EHR records how much time you spend reading alerts. If it's virtually nil, and something happens to a patient as a result, you may have a problem in court, Sterling says.

Even if you're a hospital employee and the hospital turns off some drug alerts, a plaintiff attorney may show that one of those alerts might have prevented injury to a client and, in discovery, may ask why such a valuable tool isn't being used, Sharona Hoffman says. You may think, "Not my problem." But think again. Both the hospital and an individual physician may be jointly sued.

Pitfalls of Using an EHR in Nonstandard Ways

Many EHRs are touted as being highly customizable, and many doctors purchase an EHR with the idea of tinkering and tweaking to get it just right for their practices. And most EHRs can indeed be customized -- if you know what you're doing. If you don't, and you get sued, it could harm you in court.

"'Customization' means different things, depending on the product you're using," says Sterling, the EHR consultant. "Some products actually allow me to go in and change the nature of the product so it isn't doing what it was supposed to do as advertised, and/or I use the product in a nonstandard way, so it doesn't do what it's supposed to be doing. If you're not using it in a way that maintains patient information in a reliable way, you could run into a problem."

Say you bypass the way the EHR is designed to have information entered, he offers by way of example. "Instead of checking off a box that says the patient is allergic to penicillin, I put that into a note," he says. "The system's not going to be smart enough to figure out the note to know that the patient's allergic to penicillin. If the patient has a serious emergent problem, and he needs to see me in three months so I can check on the status of the problem, if I type that into the note, it's not something the system will track. It's not something the system will manage, and therefore it's not information that's going to be used."

"If something bad happened, and I were being investigated for a claim of medical professional liability, plaintiff attorneys are going to look at it and say, 'Were you using the system as it was intended?'" Sterling elaborates. "If I say, 'I don't fill out this form that came with the system; I have my own form,' the lawyers will say, 'Oh, really? Well, did you know that your form isn't used by the system to figure out whether you do CDS rules, which can trigger care items? The patient should have had this, or the patient should have had that.'"

"If you don't check the right boxes to trigger those events, they're not going to happen," Sterling continues. "Therefore, the system's not going to inform you that you need to check on this patient's A1c level because he's diabetic or check on that patient's glaucoma because she has an eye pressure problem. If used in a nonstandard way, the system isn't smart enough to figure how to trigger these alerts, and therefore you may not have been staying on top of patient care."

"The problem is not doing the customization," he adds. "The problem is doing the customization so that it works. Everyone sits there and says, 'Oh, it's so easy to do.' But sometimes it's not so easy."

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