New Malpractice Risks in Your EHR

Ronald B. Sterling, MBA, CPA

Disclosures

January 22, 2019

In This Article

Lower Malpractice Risk Through Video Visits (Telemedicine)

Telemedicine visits are conducted through a HIPAA security-compliant web meeting with a patient. A physician might conduct a video visit in response to a care management issue, receipt of the secure message from the patient portal, or scheduled in place of an office visit. Telemedicine visits may include use of web-enabled diagnostic tools, such as a spirometer and a blood pressure/pulse device.

To lower malpractice risk, the physician or practice must document the encounter on a timely basis and ensure that the instructions and recommendation to the patient are clearly conveyed and any follow-up issues addressed on a timely basis. Note that the patient may record the telemedicine visit. It may be a useful tool to encourage patient care and support the due diligence efforts of the physician or practice, as long as the telemedicine visit is properly structured and conducted to explicitly and clearly communicate the physician's decisions and recommendations.

Additional follow-up with patients on video visits may be a critical component to your patient service strategy that will also lessen the chance of any problems. For example, a recommendation to change medications during a video visit may trigger a follow-up call on the effect of the medication change through a care management arrangement.

EHR Modularization Presents New Lawsuit Threats

With several EHRs, the evolving patient care requirements, including care management and telemedicine, are addressed through interfaces to specialized software. Many EHRs have been interfaced with patient portal, care management, patient contact management, and diagnostic software. Interfaced products typically exchange a subset of information that is used to support the patient services but may complicate patient record-keeping and raise your malpractice liability risks.

To understand the complete situation, and also see the potential danger, a physician or staff may have to access several software systems. For example:

  • Some EHR vendors use a third-party patient portal that maintains its own records of interactions with patients outside of the basic EHR. The patient portal interactions are not visible from the EHR view, and the physician may not get an accurate sense of the patient's evolving condition.

  • Care management software may allow the user to create a report from the patient services, which is saved as an image on the EHR. The care management information may be reviewed through accessing the image, but the care management information will not be displayed in context with EHR-based activities, such as prescriptions issued or telemedicine information.

EHR modularization complicates the management of patients. It means that physicians need to pay attention to all modules to ensure that all patient issues are addressed promptly. To avoid problems, HCOs need to have a strategy to ensure that all doctors and staff are aware of the source and structure of interfaced systems. They also need to be trained on how to access patient information on the interfaced systems. For example, all patients on a care management plan that uses an interfaced care management system should be clearly flagged in the patient's EHR record.

HCOs are subject to several patient care and technological changes that affect patient service expectations and responsibilities as well as affecting the underlying medical professional liability risk. Although physicians and HCOs are not obligated to use any specific EHR feature or capability, failing to use EHR-based tools to address value-based medicine and meet changing patient expectations may undermine the ability of the practice or HCO to succeed.

On the other hand, making use of the added features that the EHR brings to "stretch the clinic" and improve patient engagement will help create success. Physicians will build a better patient service method, and the underlying records that document care efforts will help protect physicians if a lawsuit occurs.

Ronald Sterling is a nationally recognized EHR expert and serves on the Medscape Business of Medicine Advisory Board.

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