Did you override an EMR's alert?
Be prepared to explain why
Do you routinely ignore warning prompts given by an electronic medical record (EMR)? The alerts, given when providers prescribe a drug to which the patient is allergic, or for which there is an interaction, do increase safety, says John Davenport, MD, JD, physician risk manager of a California-based HMO, "but in order to avoid their own liability, the allergies and interactions programmed into these systems tend to be exhaustive and often include trivial or rare reactions."
This factor often causes "alert fatigue" — the automatic overriding of a warning prompt by providers, says Davenport. "When you override a warning prompt, be prepared to answer the trial question, Isn't it true that your computer record warned you that the drug you were prescribing could cause a reaction with this patient's medication?'" he advises.
Ideally, says Davenport, the physician can truthfully respond that he or she was aware and judged the interaction or potential allergy to be trivial. "It would further support your care and defense to be able to point to specific documentation of this opinion and that you discussed it with the patient," he says. Davenport recommends giving feedback to the EMR provider to help them design and fine-tune more reasonable alerts.
Another potential legal risk involves the ease with which EMR prescriptions can be refilled, says Davenport. Though a medication might be refilled with just one click, it still is the physician's responsibility to know that the drug being refilled is the proper drug in the proper amount for the patient's condition, he advises.
"A common fact pattern seen in litigation is failure to monitor a prescription drug — liver function when refilling statins, or electrolytes when refilling diuretics, for instance," says Davenport. "The ease of EMR prescription refills contributes to this."