While electronic health records have been shown to improve patient health, safety and care coordination in many ways, what is less documented is how EHRs can also cause harm, and even leave healthcare professionals open to malpractice suits.

Trish Lugtu, associate director of research at the Minneapolis-based medical liability insurance company MMIC, points to one case in which an anesthesiologist didn’t have critical information available in his views of the EHR that would have told him a patient wasn’t a candidate for the type of anesthesia used for a certain procedure.

The patient ended up being paralyzed from the waist down, she said.

This is just one example Lugtu will explore in her session, “When EHRs Cause Patient Harm: Lessons from Malpractice” at HIMSS16.

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“I’ve found that there is a pretty even split between what I’ll call ‘unsafe technology’ and ‘unsafe use,’” she said of the contributing factors to EHR-related malpractice claims.

“Unsafe technology,” she added, “encompasses those issues that the provider generally can’t control in the moment or at the point-of-care, such as the way templates and workflow are configured, adequacy of fields to document, or how lists appear in dropdowns.”

Technical issues such as downed systems or broken interfaces can also problematically affect access to EHRs. But Lugtu warned that “we need to be careful not to fall into the trap of immediately blaming vendors."

While vendors obviously need to be involved to fix some issues, Lugtu says the healthcare organization is responsible, too, for its level of engagement during implementation of a new system or module and the security safeguards put in place.

Meanwhile, unsafe use -- everything from insufficient education and training to plain-old human error -- can also be a factor. Here, too, careful implementation comes into play. “For example, blanket decisions about what data to convert for a patient population can eliminate crucial information for a few patients,” Lugtu explained “or processes may be under-developed for accessing information in a hybrid [electronic and paper] environment.”

To combat such blind-spots, Lugtu advocates for stronger partnerships between health IT and risk managers, each of whom often “only sees half of the problem,” as well as between health IT professionals, the care team, and the patient.

“Health IT people typically do not consider themselves as part of the care team nor are they treated as part of the care team, so the perception that EHR risk factors are just IT issues rather than patient safety issues creates a lack of real urgency,” Lugtu said. “The crux of the matter is that a broken interface isn’t just an IT issue to the patient whose life depends on it.”

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Noting that EHR risks have been “well-speculated in the past,” Lugtu pointed out that “granular data” on claims is only starting to catch up with technological advances. 

“We’re five years into Meaningful Use reporting now, and the rate of EHR implementation has increased 63 percent over the same time frame,” she said. “So what volume of malpractice cases and patient harm will that mean in the next five years?”

The session "When EHRs Cause Patient Harm: Lessons from Malpractice,” is slated to take place March 3, 2016 from 1 to 2 p.m. in Palazzo E at the Sands Expo Convention Center.

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