Can Electronic Health Records Impact Malpractice Liability?

In other words, he said, “EHRs can be time sinks, and the one commodity we physicians have less of than anything else is time.”

If anything, said Dr. Kossman, EHRs may increase the risk of medical errors. “Say I want to order a chemotherapy regimen on a dosing schedule individualized to a particular patient. My system does allow me to do that, but I have to modify something that someone else has established for me, and when I do that, I’m more apt to make a mistake.” He also cited the problem of “cloned” notes: “One doctor enters his own notes into the record. Then a second doctor sees that patient and, if nothing different has happened in the interim, he or she may cut and paste the first doctor’s note, perhaps adding one sentence. If that doctor has not read everything the first doctor wrote, they might put in something that’s incorrect, or they may miss the first MD’s point. So, many of us think there’s a lot of potential for malpractice issues.”

Other doctors echo his concerns regarding the temptation to cut and paste information. “There’s a real liability to just pulling data forward from past visits that aren’t meaningful to this particular encounter and may actually end up being wrong because things have changed, but they don’t get changed in the record,” said Dr. Lusk. “You have to take the time to review the information and ensure that it is correct, and busy clinicians may not always do that.”

But, he added, “that’s no different than what happens with paper charts that have been dictated. It’s still incumbent on you to go and read through it and, honestly, most of us don’t always take the time to do that. At least with EHRs, you get immediate feedback.”

Indeed, many of the criticisms leveled at EHRs, such as the time and trouble involved in looking for a specific piece of information or wading through old notes, also hold true for paper-based systems, said Dr. Simon. He conceded that system incompatibility remains an important challenge. “In a perfect world, every system would be able to communicate with each other freely, but that’s not a reason not to use EHRs. In my opinion, the benefits greatly outweigh the drawbacks.”

Otolaryngologists: In the Forefront…Or Not?

Opinions differ on how quickly otolaryngologists have entered the brave new world of EHRs. “I think otolaryngologists have been much quicker than average to adopt them,” said Dr. Ermini. “A lot of the early and current commercial systems came out of otolaryngology. The problem is that as we go to a national health information network, a lot of those early systems won’t mesh with the needs of that system and will have to be redesigned.”