Real-world examples of how issues with the EHR can lead to patient injury or death.
Claims in which electronic health records (EHRs) contributed to injury grew from seven cases in 2010 to an average of 22.5 cases per year in 2017 and 2018, according to an analysis by the Doctor’s Company.
The most EHR-related claims during the eight-year span were due to system technology and design issues or by user-related issues. While the “other” category had 30 claims, making up 14% of the total 216 claims closed during that time, system failure (26 claims, 12%) and failure of EHR alerts (15 claims, 7%) made up 41 cases and 19% of reported claims, the medical malpractice insurance company found.
Although the cases are not necessarily common, they lead to some serious outcomes.
One example of an EHR error: A physician treated a patient with trigger point injections of opioids for pain management. But although the physician intended to order 15 mg of morphine sulphate to be administered every eight hours, the physician accidentally selected 200 mg when presented with the drop-down menu in the EHR.
Because of the mistake, the patient took one dose of the prescription with Xanax and developed slurred speech and was taken to the emergency department. The patient was hospitalized overnight and filed a malpractice claim against the physician for emotional trauma and the costs of the hospital stay.
Another example: after a female complained about sinus issues, a physician planned on ordering Flonase nasal spray for the patient to take as directed. But two weeks later, the patient was suffering from dizziness and went to the emergency department. This happened because the ordering physician mistakenly ordered Flomax for the patient, which is a medication for enlarged prostate with hypotension as a side effect.
The ordering physician entered “FLO” into the order screen and the EHR automatically selected Flomax, without the physician realizing.
That EHR did not have a drug alert for gender.
Other EHR issues led to a delay of return to surgery and partial paralysis in a patient who was diagnosed with severe lumbar stenosis at the emergency department. Nurses noted neurological changes and called the physician, but no action was taken. Because of the fragmented patient record, information was not relayed to the proper physician.
Claims filed for user related EHR issues were due largely to incorrect information (29 claims, 13%), pre-populating (29 claims, 13%), hybrid health records (27 claims, 13%) and user error (25 claims, 12%), the Doctor’s Company found.
Pre-populating issues like copy-and-paste play a large role and could lead to the deterioration of a patient.
For example, a patient with obesity saw the physician for medical clearance. His test results were normal, but he returned three months later due to shortness of breath and dizziness. His blood pressure was 112/90 and his pulse was 106 and no tests were ordered.
The patient died from a pulmonary embolism five days later. The progress note for the patient was identical to the note from three months earlier, including spelling errors and old vital signs.
Among the top clinical services with EHR factors include family medicine, internal medicine, cardiology and radiology. And among the claims that Doctor’s Company analyzed, death (25%) and adverse reaction to a medication (23%) were the most prevalent EHR-related claims.
Doctor’s Company recommends avoiding copying and pasting except to describe the patient’s past medical history. It is also important for physicians and specialists to review their entry after making a choice from an EHR drop-down menu to avoid errors. Physicians should also review all available data before treating a patient to avoid injury due to not making use of available information, Doctor’s Company suggested.
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