Electronic Health Records and Malpractice Claims in Office Practice (original) (raw)

The relationship between electronic health records and malpractice claims

Archives of internal medicine, 2012

Electronic health records (EHRs) have the potential to advance the quality of care, but studies have shown mixed results. The authors sought to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability.

Electronic Health Record–Related Events in Medical Malpractice Claims

Journal of Patient Safety, 2015

Background: There is widespread agreement that the full potential of health information technology (health IT) has not yet been realized and of particular concern are the examples of unintended consequences of health IT that detract from the safety of health care or from the use of health IT itself. The goal of this project was to obtain additional information on these health IT-related problems, using a mixed methods (qualitative and quantitative) analysis of electronic health record-related harm in cases submitted to a large database of malpractice suits and claims. Methods: Cases submitted to the CRICO claims database and coded during 2012 and 2013 were analyzed. A total of 248 cases (<1%) involving health ITwere identified and coded using a proprietary taxonomy that identifies user-and system-related sociotechnical factors. Ambulatory care accounted for most of the cases (146 cases). Cases were most typically filed as a result of an error involving medications (31%), diagnosis (28%), or a complication of treatment (31%). More than 80% of cases involved moderate or severe harm, although lethal cases were less likely in cases from ambulatory settings. Etiologic factors spanned all of the sociotechnical dimensions, and many recurring patterns of error were identified. Conclusions: Adverse events associated with health IT vulnerabilities can cause extensive harm and are encountered across the continuum of health care settings and sociotechnical factors. The recurring patterns provide valuable lessons that both practicing clinicians and health IT developers could use to reduce the risk of harm in the future. The likelihood of harm seems to relate more to a patient's particular situation than to any one class of error.

Electronic health records: which practices have them, and how are clinicians using them?

Journal of Evaluation in Clinical Practice, 2008

Background Limited data exist to estimate the use of electronic health records (EHRs) in ambulatory care practices in the United States. Methods We surveyed a stratified random sample of 1829 office practices in Massachusetts in 2005. The one-page survey measured use of health information technology, plans for EHR adoption and perceived barriers to adoption. Results A total of 847 surveys were returned, for a response rate of 46%. Overall, 18% of office practices reported having an EHR. Primary-care-only and mixed practices reported similar adoption rates (23% and 25%, respectively, P = 0.70). The adoption rate in specialty practices (14%) was lower compared with both primary-care-only ( P < 0.01) and mixed ( P < 0.05) practices. The number of clinicians in the practice strongly correlated with EHR adoption ( P < 0.001), with fewer small practices adopting EHRs. Among practices that have EHRs with laboratory and radiology result retrieval capabilities, at least 87% of practices report that a majority of their clinicians actively use these functionalities, while 74% of practices with electronic decision support report that the majority of clinicians actively use it. Among the practices without an EHR, 13% plan to implement one within the next 12 months, 24% within the next 1-2 years, 11% within the next 3-5 years, and 52% reported having no plans to implement an EHR in the foreseeable future. The most frequently reported barrier to implementation was lack of adequate funding (42%). Conclusions Overall, fewer than 1 in 5 medical practices in Massachusetts have an EHR. Even among adopters, though, doctor usage of EHR functions varied considerably by functionality and across practices. Many clinicians are not actively using functionalities that are necessary to improve health care quality and patient safety. Furthermore, among practices that do not have EHRs, more than half have no plan for adoption. Inadequate funding remains an important barrier to EHR adoption in ambulatory care practices in the United States.

Electronic Health Records and Patient Safety

Applied Clinical Informatics, 2015

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were ...

Electronic medical record use by office-based physicians and their practices: United States, 2006

Advance data, 2007

This report presents the latest information on the use of electronic medical records in physician offices. Percentages of medical practices and physicians within the practices using electronic medical records (EMR) are presented for 2006 by selected physician and practice characteristics. Data from the physician induction interviews of the 2006 National Ambulatory Medical Care Survey (NAMCS) are presented. NAMCS includes a national probability sample of nonfederal office-based physicians who saw patients in an office setting. Sample data were weighted to produce national estimates of physicians. Estimates of medical practices were derived from NAMCS physician data by adjusting the weighting scheme using a multiplicity estimator. In 2006, 29.2 percent of office-based physicians reported using full or partial EMR systems, which represented a 22% increase since 2005 and a 60% increase since 2001, when the NAMCS began monitoring this technology. Starting in 2005, the NAMCS included ques...

Physicians and Electronic Health Records

Archives of Internal Medicine, 2007

Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit documentation to laboratory test ordering, but little is known about physicians' actual use of these functions.

Association between Electronic Health Records and Health Care Utilization

Applied clinical informatics, 2015

The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. To determine any association between EHRs and health care utilization. We conducted a cohort study (2008-2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determi...

Electronic health records in ambulatory care—a national survey of physicians

New England …, 2008

Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption.