Just three types of medical errors account for the majority of EHR-related patient harm events cited in malpractice claims.
According to a new study published in the Journal of Patient Safety, medication and diagnostic errors, and complications with treatment account for 90 percent of claims citing EHRs. Medication errors and complications of treatment each represented 31 percent, and diagnostic errors came in at 28 percent.
What does the research show?
To arrive at these findings, researchers looked at claims submitted to the CRICO Comparative Benchmark System (CBS), a national database of medical malpractice claims from both commercial and captive insurance companies. According to the study, the data is reflective of “both hospital and clinician risk in academic and community environments and across all care settings.” Researchers ultimately analyzed 248 incidents occurring between 2012 and 2014.
Other prominent findings from their research include:
- Majority of the cases (146) came from the ambulatory care setting, compared to 77 in-patient and 25 ED cases. That said, in-patient errors were most common among nurses.
- There were no cases from extended care facilities.
- The services with the most claims were Medicine, followed by Surgery, Nursing, and Obstetrics/Gynecology and Radiology.
- User-related EHR issues were more common (63 percent) than technology/system-related issues (58 percent).
- User and tech problems were roughly equally dangerous, with 29 and 26 percent respectively resulting in death.
- More than 80 percent of all cases were considered high or medium severity.
- Ambulatory care cases were less likely to be lethal (18 percent) than in-patient or ED cases (39 percent).
Findings regarding the most common types of errors include:
- Of the 76 medication-related errors, the most common problems were related to ordering, improper management and administration.
- Diagnostic errors were the leading allegation in ED and ambulatory settings. Of the 69 diagnostic errors, 30 resulted in death.
- Of the 42 diagnostic cases with a user-related issue, 32 were ambulatory cases, and the dominant EHR-related codes were difficulty during an EHR conversion (16 cases), failing to appreciate a deteriorating clinical situation due to pre-populating or copy/paste (10 cases) and misrouted information (7 cases).
- 28 of the diagnosis-related cases involved delayed diagnosis of cancer; 25 acute problems such as myocardial infarction (5 cases), cardiomyopathies or endocarditis (5 cases), pulmonary embolism (4 cases), pneumonia (3 cases), or other infections (8 cases). The remaining cases involved delayed or missed diagnosis of fractures, HIV and post-operative complications.
The authors used this data to conclude that EHR-related harm is more severe than previous patient-safety reporting programs indicated. They also remind readers that such errors can occur in any care setting.
“Healthcare professionals, their organizations, and health IT vendors can decrease the risk of harm related to using electronic medical records by appreciating and addressing the lessons that these cases provide,” the researchers conclude.
What are some takeaways from this research?
Avoid using hybrid systems.
When converting from one EHR system to another, upgrading or adding a new functionality, establish “a well-defined action plan and appropriate resources to ensure complete and accurate data is available as rapidly as possible,” the authors write.
Don’t assume the EHR system is always working as you think it should.
Common examples of system failures include delays in returning critical laboratory values, important pathology results getting lost or misdirected, incorrectly pasted information, and urgent products being misrouted.
“Providers need to appreciate these vulnerabilities so that they can take appropriate steps to validate data, to ensure timely follow up on tests that are ordered, or to inquire directly about services or products that appear delayed. If key data is missing in the EHR, providers need to find it,” the authors advise.
Avoid using “workarounds.”
Limit the use of copy-paste functionality. When ever possible, use simple EHR interfaces, improve EHR training, and promote health IT standardization. Don’t override medical alerts.
Remember: The EHR does not replace clinical judgement.
The study calls it “over-reliance on EHR … Just as quality in clinical care involves constant monitoring and questioning to ensure that diagnosis and treatment are correct, there should be a comparable level of vigilance and appreciative inquiry in regard to using the EHR. Data and information that raises an eyebrow should be verified or rechecked.”
Electronic Health Record–Related Events in Medical Malpractice Claims, Journal of Patient Safety.
Last updated on 10/8/19.