Darrell Ranum, JD, Vice President of Patient Safety and Risk Management

For 8 years, claims in which the use of electronic health records (EHRs) contributed to patient injury have been on the rise.

The Doctors Company's analysis of claims in which EHRs contributed to injury show a total of 216 claims closed from 2010-2018. The pace of these claims grew, from a low of 7 cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. EHRs are typically contributing factors rather than the primary cause of claims, and the frequency of claims with an EHR factor continues to be low (1.1 percent of all claims closed since 2010). Still, as EHRs approach near-universal adoption, they may become a more prevalent source of risk.

The EHR-related claims closed from 2010-2018 were caused by either system technology and design issues or by user-related issues.

Here are the top five risks and suggestions to avoid an EHR-related malpractice claim:

1. Risk: Copy/paste may perpetuate incorrect or outdated information.
   Solution: Avoid copying and pasting except when describing the patient's past medical history.
2. Risk: Many EHRs auto-populate fields in the patient's history and physical exam and in procedure notes, causing the entering of erroneous or outdated clinical information.
   Solution: Contact your organization's IT department or your vendor if you notice that the auto population feature causes erroneous data to be recorded. If the auto populated information is incorrect, note it and document the correct information.
3. Risk: Templates with drop-down menus facilitate data entry, but an entry error may be perpetuated elsewhere in the EHR.
   Solution: Review your entry after you make a choice from a drop-down menu.
4. Risk: Doctors are responsible for the information to which they have reasonable access. EHR metadata documents what was reviewed. A patient injury may result from a failure to access or make use of available patient information.
   Solution: Review all available data and information prior to treating a patient.
5. Risk: The computer may become a barrier between the doctor and the patient.
   Solution: Relocate the computer so the physician's back is not to the patient and so the patient can view the screen. Remind the patient that you are listening carefully, even though you may be typing during the appointment and summarize or read the note to demonstrate you have listened.