Preventing Medical Liability through EHR Missteps

Those in healthcare are all too aware of the high financial and personal costs involved if something goes awry. This is especially true as EHRs are woven into everyday care and one electronic misstep can lead to disaster.  

“IT in the healthcare industry is so much different than IT in any other industry. What other industries do we have where IT can lead directly to patient harm, injuries, or death?” asked Trish Lugtu, CPHIMS, associate director of research at MMIC, a medical liability insurance company in Minneapolis. Lugtu presented a session examining the potentially harmful effects that can result from EHRs at the annual Healthcare Information and Management Systems Society conference in Las Vegas.

Though EHRs are relatively new on the industry scene, Lugtu said it is important to realize that blame for issues that arise from them cannot be placed wholly with the technology. “If you’re familiar with risk management, you know this is not new, but it is a new story with EHRs. EHRs work like machines because they are machines, and they do their job very well,” she said.

The top EHR-related factors that lead to patient harm can be divided into two categories: unsafe use (user-related issues) and unsafe technology. User-related issues include inappropriately copying and pasting information, inputting incorrect information, and routing electronic data wrong; while technology problems may include pre-populated data that is inaccurate, incorrect system or software design, or system dysfunction or malfunction.

Lugtu emphasized risk management and IT remain at the forefront of reducing patient harm, even in the face of potential user-related issues. “Even though we’re not directly interacting with patients directly, we’re maintaining those instruments for patient care,” she said.

To do this, healthcare teams need to build a common language. Both the clinical and IT sides use a vocabulary that isn't easily understand by those who work outside their particular space in the industry. “Our language doesn’t sync up, and we don’t even realize it,” Lugtu said. With all the parties involved in patient care, it is important to establish a shared language for communication across the entire team.

Additionally, organizations need to establish rights and responsibilities of EHR users. For example, if physicians have uninterrupted access to records, and they have access to see all necessary data to make clinical decisions, they need to be held accountable for security and accurate and up-to-date records. From the IT side, offering training and assistance to the organization on proper EHR protocol means technology staff should be available to answer questions and help others in the organization maintain proficiency and stay updated on changes in the system.

To address unsafe technology and unsafe use, Lugtu suggested putting protocols in place that examine issues such as system design/configuration, electronic routing of data, pre-populated data and defaulted data. In creating these detailed checks and balances, she said that both the IT team and clinicians need to make these decisions. “Both clinicians and health IT people need to be at the table,” she said. “The IT people don’t understand the intricacies of patient care, and the physicians feel intimidated by the technology, but they need to be communicating.”

Not doing so is a serious issue: “Accidents and oversights aren’t just unintended consequences,” she said. “These are patients’ lives.”