Manage risks of electronic records to avoid liability
Electronic medical records (EMRs) are quickly becoming the standard in healthcare, but managing the risks posed by the technology might be lagging behind, cautions Allan Ridings, senior risk management and patient safety specialist with the Cooperative of American Physicians (CAP) in Los Angeles.
CAP was formed in 1975 by a group of California physicians who came together to tackle the problem of ever-increasing medical malpractice costs. Ridings says the use of EMRs is a positive step for healthcare but that risk managers might need to step up their risk assessment because some hazards are surprising.
Take pediatric weights and measures, for example. Some EMRs default to the imperial weights and measures used in the United States, but all medications are measured with the metric system.
"It seems so obvious, but it’s the kind of thing that can go overlooked until you have a problem," Ridings says. "You need to be consistent across the board so that when you’re entering information you don’t have to remember to enter it in imperial measures here but then switch to metric for the medications. That’s the kind of thing that should be addressed when you’re first setting up your EMR."
Ridings notes that he once saw a physician practice using an EMR system that allowed a patient to be pregnant for nine years. Users expect that sort of obvious error to be impossible, he says, but simple computer programming errors can allow failures that threaten patient safety.
EMRs also are sometimes are set up with no controls on what medication a physician can order, notes Joseph Wager, also a senior risk management and patient safety specialist at CAP. He recalls working with one hospital that had an EMR allowing a physician to order 25,000 units of heparin, for example.
"The system should catch entries that are way out of the ballpark like that," Wager says. "Your system has to have controls in it."
Naming conventions also are a risk, Ridings says. The EMR should recognize that a drug is not correct for pediatrics, for instance, or that the method of administration is not conventional.
Drop-down menus can be risky, as well. Wager recalls an incident in which a doctor inadvertently ordered the wrong dosage of a drug by clicking on the wrong item in a drop-down menu.
Altering the EMR must be done correctly, Ridings notes. As with paper records, an EMR must reflect the actual record and not be altered, but the doctor or nurse can add to it. "Data is always discoverable, so you don’t want to alter the record by going in and just erasing some entry and putting in the new information," Ridings says. "Some systems allow clinicians to just write over the information, and that is a very dangerous practice. The record should be locked once information is entered and only additions are allowed."
Ridings and Wager urge particular caution with EMR systems that do not come with sufficient training for users. Some less expensive systems come with little or no training, they note.
"Everyone should be trained appropriately on the system and especially on any changes that you make to the system as you use it and find ways to improve it," Wager says. "An EMR can be a terrific tool for a healthcare provider, but it is a tool that comes with lots of hidden risks."
- Allan Ridings, Senior Risk Management and Patient Safety Specialist, Cooperative of American Physicians, Los Angeles. Telephone: (800) 252-7706. Email: aridings@CAPphysicians.com.
- Joseph Wager, Senior Risk Management and Patient Safety Specialist, Cooperative of American Physicians, Los Angeles. Telephone: (800) 252-7706. Email: jwager@CAPphysicians.com.