As electronic medical records (EMRs) proliferate under federal regulations, kludgey workflow processes and patient data entry quality can be problematic.
The inherent issues with EMRs -- and for the healthcare professionals required to learn them -- hasn't been lost on lawyers, who see the potential for millions of dollars in judgments for plaintiffs suing for medical negligence.
Keith Klein, a medical doctor and professor of medicine at the David Geffen School of Medicine at UCLA, described four such cases where judgments reached more than $7.5 million because the data contained in an EMR couldn't be trusted in court.
Klein, who spoke at the Healthcare Information Management Systems Society (HIMSS) conference here today, said he has served as a legal expert in more than 350 medical lawsuits in state and federal courts. And while medical malpractice cases have so far focused on physicians and hospitals, Klein said technology vendors are next on the list.
"There are attorneys now looking for a clean case to sue the vendor," he said. "This is reality. It is not theoretical. I was approached by Washington, D.C. law firm who had a very clean case for suing a vendor."
Klein declined to be an expert in the case, but the problem will persist.
EMRs require physicians to perform their own data entry, stealing precious face time with patients. What had been a note jotted into a paper record, now involves a dozen or more mouse clicks to navigate a complex EMR workflow.
Healthcare providers can be prone to taking shortcuts on entering the data or not entering it in a timely manner, Klein said. Vital sign data is often duplicated as it moves between hospital departments, but it remains part of one integral patient record.
Data administrators may copy and paste patient information from an older record to a newer one, supposing that the data would remain the same. And the sheer complexity of EMRs pose issues with accuracy, as being able to track who has entered what data, and when, over time can become confusing.
"This is a fire hydrant," Klein said. "Try to take a drink out of it. That's what it's like trying to read an EMR."
One recent lawsuit involved a patient who suffered permanent kidney damage when he was given an antibiotic to treat what was thought to be an infection resulting in elevated creatinine levels. The patient was also suffering a uric kidney stone, which precludes the use of the antibiotic. Because of the complexity of the EHR, none of the attending physicians noticed the kidney stone.
Detracting from the EMR's validity was the fact that a date related to a previous intravenous drip was repeated over and over on all 3,000 pages of the record.
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