Plaintiffs’ attorneys are on the lookout for several malpractice theories that trace patient harm back to an electronic health record (EHR) that was flawed in its design or used improperly by clinicians, says Marion Munley, JD, an attorney in Scranton, PA, who has briefed others in her field.
Munley provides this summary of the types of EHR flaws that plaintiffs might cite in malpractice allegations:
- Imperfect clinical decision support. Most EHRs generate alerts for allergies and drug contraindications, along with prompts for commonly ordered tests, drugs, and treatment plans for the indicated condition. While widely hailed as a benefit from EHRs, this clinical decision support is one of the biggest opportunities for plaintiffs’ attorneys. They can blame the EHR if the information offered is incorrect, if the system fails to offer information that might have helped the patient, or if the clinician did not heed the warning or follow up on the suggestion.
- Lax log-in security. It is not uncommon for physicians and nurses to allow others to use their log-in to access the EHR, simply as a convenience and a timesaver. This habit can lead to serious problems if a plaintiff’s attorney finds out about it. Even if it cannot be proven that it happened with a particular patient’s care, poor log-in security can cast doubt on who prescribed treatment, medication, and tests for a patient, or who is responsible for alterations made to health records. The accuracy of the entire EHR might be questioned.
- Data loss from system upgrades. Many people are familiar with how a smartphone or computer upgrade can result in at least a temporary loss of data and, frequently, confusion about where familiar features have been moved. The same can occur with an EHR upgrade, and patient safety can be compromised as clinicians adapt to the upgraded system.
- Auto-conversions or auto-fill features. When an EHR has these built-in features, numbers can be converted without the user noticing, which can lead to an incorrect drug dosage, for example.
- System templates. Any kind of template or “boilerplate” feature in an EHR can threaten patient safety when it leads to recording inaccurate data for a patient rather than taking the time to customize the record.
- Incompatibility. When software used by one healthcare facility cannot communicate fully with software elsewhere, critical information might be lost.
- Copy-and-paste errors. Using the copy-and-paste feature can save tremendous amounts of time when entering routine information and descriptions in a patient’s record, but it also risks introducing errors or omitting important data. Even if errors are minor, a plaintiff’s attorney might cite cutting and pasting information as evidence of a lack of attention to detail.