Malpractice Errors That Can Result from EHR

1. Malpractice Errors That Can Result from EHR 918-221-7809

2. It is critical for physicians to be aware of EHR-related errors that can lead to malpractice lawsuits and how to prevent them. EHR-integrated medical transcription services go a long way in helping to prevent documentation errors that can cause medical misdiagnoses and medical mistakes. According to a Physicians Practice report published in June 2017, studies show that while EHRs are not the primary reason for medical malpractice suits, they are a contributory factor.

3. Certain malpractice errors that can result from EHR use include: Copy-paste/Careless use of templates Though copy-paste can save time, physicians must make sure that this does not compromise relevant information and lead to incorrect data that will affect patient care. While using EHR templates and copy-paste, physicians need to be mindful of preventing mistakes such as:

4. Lack of individualized patient records • Confusion in gender identity • Note bloat at each encounter • Records with several blanks • Recurring typos and spacing errors • Sequential use of similar phrases

5. Drop-down menus and auto-complete tool Even though EHRs support capture of information from drop-down menus, this can make the user click on the wrong item in the menu, leading to data error. Overuse of the auto-complete tool can also lead to lack of data integrity. Using free text to record individualized information about patients can prevent these problems.

6. EHR data entry affecting physician-patient communication • According to the Medical Economics report, patients sue physicians when they feel disrespected and that physicians aren’t paying attention to them. The report recommends providers to abbreviate their findings and update the record with their findings later. • Other options include having a scribe in the room or outsourcing clinical documentation tasks to an experienced medical transcription company.

7. Missing data An "interface breakdown" due to poor technology design can result in providers missing necessary information If the system did not route the information properly the EHR may fail to display a test result to make a proper diagnosis

8. Meta data and ignoring EHR alerts Metadata can help analyze or interpret clinical information within the EHR. It reveals the alerts the physician saw while documenting medical details. 1 Physicians can flag the amended EHR record and include a narrative entry in the medical record statement, clearly documenting the original error and the correction for future reference. 2

9. Strategies to avoid EHR-related errors (Northbay Business Journal) • Review all available patient information • Heed and reconcile drug interaction alerts • Pay attention to warnings, reminders, and established practice guidelines • Don’t copy-paste indiscriminately from progress notes • Make sure that the documentation reflects the patient’s condition by using templates correctly

10. Don’t let EHR data entry affect communication with the patient • Choose a well-designed EHR • Understand that all EHR-interactions are time-tracked and discoverable • Adhere to HIPAA regulations related to confidentiality of personal health information • Comply with federal and state record retention laws before shredding old records and scanning or entering paper records into the EHR

11. Partnering with reliable medical transcription companiescan help minimize the risk of electronic health record related malpractice suits. Contact us: Headquarters:8596 E. 101st Street, Suite HTulsa, OK 74133 Phone: 918-221-7809 Thank You…