Comments on: Do electronic medical records decrease liability risk? http://www.kevinmd.com/blog/2009/12/electronic-medical-records-decrease-liability-risk.html Wed, 15 Feb 2012 00:14:00 +0000 hourly 1 By: MillCreekhttp://www.kevinmd.com/blog/2009/12/electronic-medical-records-decrease-liability-risk.html#comment-122070 MillCreek Tue, 22 Dec 2009 15:42:54 +0000 http://www.kevinmd.com/blog/?p=41625#comment-122070 I forgot to mention: the "too much information" comment refers to "alert fatigue". Many EMRs are set so that when you first start them up in the morning, the first screen you see is a page of various alerts, such as critical lab values, reminder for Mrs. Jones' colonoscopy, 23 pharmacy refill requests and the like. You have to click and act upon each alert to make it go away.There is some thought that faced with an unmanageable number of alerts, some clinicians just click on them to make them go away. This is called alert fatigue. Suffice it to say that this can come back to bite you in the ankle should something go awry, like you miss Mr. Smith's overcoagulation status, and he strokes out. Telling the jury that you just clicked on the alert without acting upon it is going to drive up the value of the case. I forgot to mention: the “too much information” comment refers to “alert fatigue”. Many EMRs are set so that when you first start them up in the morning, the first screen you see is a page of various alerts, such as critical lab values, reminder for Mrs. Jones’ colonoscopy, 23 pharmacy refill requests and the like. You have to click and act upon each alert to make it go away.

There is some thought that faced with an unmanageable number of alerts, some clinicians just click on them to make them go away. This is called alert fatigue. Suffice it to say that this can come back to bite you in the ankle should something go awry, like you miss Mr. Smith’s overcoagulation status, and he strokes out. Telling the jury that you just clicked on the alert without acting upon it is going to drive up the value of the case.

]]> By: MillCreekhttp://www.kevinmd.com/blog/2009/12/electronic-medical-records-decrease-liability-risk.html#comment-122069 MillCreek Tue, 22 Dec 2009 15:31:10 +0000 http://www.kevinmd.com/blog/?p=41625#comment-122069 Much of my 26 years experience in healthcare risk management and professional liability claims handling has been in the ambulatory environment. Most of that was spent working for a malpractice insurer and the rest in ambulatory care. There is little, if any, data showing that EMRs substantially decrease liability claims in ambulatory care. Most of the data available is in the inpatient environment and shows some modest benefit in physcian order entry, care coordination and medication issues. Most of the insurers who offer a discount do so on a marketing basis, and not because there is data that persuades the actuaries that EMRs lower risk. In my experience, ambulatory EMRs can be beneficial in such things as alerting to allergies, alerting to significant lab/imaging results, reminding on preventative care and the like. Since most ambulatory malpractice claims are issues of clinical judgement or procedure technique, an EMR is of little help in those cases. An EMR doesn't help you when you took too long to do a c-section, clipped the CBD during a lap chole or decided to not refer that breast mass for a biopsy. Intuitively, we all think that an EMR must be of some benefit, and it will be interesting to see what the future data shows in terms of improved outcomes and/or reduced liability claims. Perhaps that will have to wait until we see more robust EMRs that integrate across the care continuum or offer more clinical decision support. Much of my 26 years experience in healthcare risk management and professional liability claims handling has been in the ambulatory environment. Most of that was spent working for a malpractice insurer and the rest in ambulatory care. There is little, if any, data showing that EMRs substantially decrease liability claims in ambulatory care. Most of the data available is in the inpatient environment and shows some modest benefit in physcian order entry, care coordination and medication issues.

Most of the insurers who offer a discount do so on a marketing basis, and not because there is data that persuades the actuaries that EMRs lower risk. In my experience, ambulatory EMRs can be beneficial in such things as alerting to allergies, alerting to significant lab/imaging results, reminding on preventative care and the like. Since most ambulatory malpractice claims are issues of clinical judgement or procedure technique, an EMR is of little help in those cases. An EMR doesn’t help you when you took too long to do a c-section, clipped the CBD during a lap chole or decided to not refer that breast mass for a biopsy.

Intuitively, we all think that an EMR must be of some benefit, and it will be interesting to see what the future data shows in terms of improved outcomes and/or reduced liability claims. Perhaps that will have to wait until we see more robust EMRs that integrate across the care continuum or offer more clinical decision support.

]]> By: Michael Kirsch, M.D.http://www.kevinmd.com/blog/2009/12/electronic-medical-records-decrease-liability-risk.html#comment-122061 Michael Kirsch, M.D. Tue, 22 Dec 2009 13:40:06 +0000 http://www.kevinmd.com/blog/?p=41625#comment-122061 While EMR will reduce some legal risks by having all medical info available, it will create a potent vulnerability. There is no easy mechanism to document the physicians thinking when documenting a diagnosis and plan. Using the fossilized paper or transcription methods, my notes on abd pain, for example, indicate a differential dx and why I am pursuing one option over others. I try to document why I don't think the abd pain is intestinal ischemia or diverticulitis, for example. These full narratives have 'set me free' in the past. I don't think that the 'point & click' method can rival this, particularly a year or two later in a deposition. Who will have time to free text all of this stuff into the EMR note? In addition, these templated assessment and plans will be deficient for medical reasons, as well as for legal protection. I receive many of them from colleagues and they are often 2 or 3 neatly packaged pages that communicate almost nothing. While EMR will reduce some legal risks by having all medical info available, it will create a potent vulnerability. There is no easy mechanism to document the physicians thinking when documenting a diagnosis and plan. Using the fossilized paper or transcription methods, my notes on abd pain, for example, indicate a differential dx and why I am pursuing one option over others. I try to document why I don’t think the abd pain is intestinal ischemia or diverticulitis, for example. These full narratives have ‘set me free’ in the past. I don’t think that the ‘point & click’ method can rival this, particularly a year or two later in a deposition. Who will have time to free text all of this stuff into the EMR note? In addition, these templated assessment and plans will be deficient for medical reasons, as well as for legal protection. I receive many of them from colleagues and they are often 2 or 3 neatly packaged pages that communicate almost nothing.

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