Can Electronic Health Records Impact Malpractice Liability?

Proponents of electronic health records (EHRs) like to claim the systems’ advantages over their paper counterparts—greater legibility, lifetime data storage, help with decision support and, ideally, accessibility by the patient’s entire clinical team—will lower the risk of medical errors and bad outcomes and, by extension, may reduce the number of malpractice lawsuits. Now a new study suggests that EHRs may do just that.

In a research letter published in June in the Archives of Internal Medicine, lead author Mariah Quinn, MD, MPH, clinical instructor of medicine at Harvard Medical School when she participated in the research and now an assistant professor of medicine at the University of Wisconsin in Madison, and colleagues point out that risk factors for malpractice suits include many of the events EHRs are designed to prevent, such as poor communication between providers, difficulty accessing patient information in a timely manner, unsafe prescribing practices and lower adherence to clinical guidelines (Arch Intern Med. 2012;172(15):1187-1189).

To determine whether there was a relationship between the adoption of EHRs and a change in the number of claims, the researchers studied closed-claims data from a Massachusetts malpractice insurer for physicians covered from 1995 to 2007, coupled with data from surveys administered to a random sample of physicians in multiple specialties in the state in 2005 and 2007. Of the 275 physicians who responded in at least one of the two years, 33 incurred 51 unique claims, 49 prior to EHR adoption and two afterward. Among otolaryngologists, the number of claims went from five prior to initiating EHRs down to zero afterward, a pattern that was repeated for many of the specialties observed. “We found that the rate of malpractice claims when EHRs were used was about one-sixth the rate when EHRs were not used,” the authors concluded.

Where Is Credit Due?

These findings were no surprise, senior author Steven R. Simon, MD, MPH, chief of the section of general internal medicine for the VA Boston Healthcare System, told ENT Today. “What surprised us was the magnitude of the effect. The data suggest that five-sixths of all malpractice claims could be eliminated if you had EHRs. That’s huge.”

Interestingly, the investigators could not trace this result to any specific feature of EHRs. “There are a number of ways in which these systems can reduce the likelihood of an error or a safety event,” said Dr. Quinn, “such as easily accessible medication lists that all providers can see, facilitation of communication among different specialists and built-in decision support to detect medication interactions that a provider might not have thought of. We’re just not able to say from our study what those specific things are.”