EHRs and Malpractice: An Attorney’s Perspective

In the closing session at AHIMA’s CDI Summit in Alexandria, VA, on Friday, attorney Marion Munley, Esq., a medical malpractice lawyer who delivered her presentation via Skype, shared cautionary tales and disquieting concerns about the inherent patient safety risks related to electronic health records (EHRs).

EHRs, Munley explains, “are sold as a panacea to us the consumers, but in reality there are many bugs and obstacles that need to be worked out before we’re assured of patient safety.”

Some high-profile cases where EHR errors led to the death of a patient include the case of an Illinois infant who was erroneously administered 60 times the prescribed dose of sodium chloride due to a conversion error in the EHR. This caused the infant to suffer a heart attack.

Another more high profile case is that of Thomas Duncan, who died from complications of Ebola in Houston, TX. According to Munley, a nurse properly documented that Duncan had been in Liberia (a risk factor for Ebola), but the treating physician wasn’t able to see that in his chart. As anyone who followed the news at the time knows, Duncan was discharged but returned to the hospital a couple days later before succumbing to the disease.

As an attorney, Munley says the most common EHR and documentation errors she sees are data entry errors, copy and paste mistakes, errors related to wrong clicks, failure of a physician to verify notes, errors caused by software updates, intentional destruction of records, and mistakes precipitated by clinical decision support alert fatigue.

Training Key to Preventing EHR Malpractice Suits

EHRs are more vulnerable to patient safety errors in the time periods immediately preceding or following software updates and go-live dates, Munley said, which means staff need to be properly trained and remain vigilant during these times.

She emphasized that if harm befalls a patient due to a glitch in the technology she will look for evidence showing whether or not clinicians have reported the issue to the vendor.

“Why didn’t doctors know there was a flaw? Why did they knowingly put a patient at risk? Or, if the doctor was aware of the flaw but made no attempt to have it corrected, it could be argued that he or she knowingly put the patient at risk,” Munley said. “For example, if a barcode scanner has an issue, that’s something that could be easily rectified. If it’s not being paid attention to, there’s going to be a whole lot of questions about who knew what when.”

Proper training will also help protect hospitals and healthcare organizations when an e-discovery process is initiated. When Munley requests hard copies of patient records for her clients, she’s not seeing the whole picture.

“Unlike paper records, changes made to EHRs cannot be observed with the naked eye,” Munley said. “If a family member or attorney requests files from EHRs, the printed out version won’t show the audit trail. If a member of the staff provides patients with printable versions that are incomplete, it can be detrimental to the provider’s defense.”

5 Comments

  1. Glad to see an attorney start to recognize and discuss how documentation errors are occurring and impacting patient safety due to poor design of dynamic EHR templates. As HIM professionals we must diligently work to educate others and work towards the elimination of inappropriate use of copy & paste, auto template population, pull forward of historical or redundant data, and the rampant HIPAA breaches occurring within the patient record due to open access. Rebuilding trust and integrity in our legal health record will only be achieved with large scale changes by vendors plus the necessary adoption of electronic document management solutions with workflow which allow full and complete record lock down for each episode of care, upon patient discharge, let alone support the needs of documentation to support ICD-10-CM/PCS. #dariceg1

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  2. “Some high-profile cases where EHR errors led to the death of a patient include the case of an Illinois infant who was erroneously administered 60 times the prescribed dose of sodium chloride due to a conversion error in the EHR. This caused the infant to suffer a heart attack.”

    I hadn’t heard about this. This is insane, isn’t it? Surely at least one person involved in preparing the medication for that child would have noticed that it was a dose entirely too large for someone so small. Do they just blindly obey what they read in the EHRs? What happened to common sense?

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    • It is insane. They should have noticed it was a high does for an infant. Even I, who is a sophomore at high school, know it can kill the infant. People now a days sadly, don’t have common sense.

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  3. Duncan’s Ebola case was in Dallas TX, not in Houston.

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