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, DC 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.
While his physicians claimed they'd documented his care properly, the EMR was so complex and filled with repetitive data, the judge found it in inadmissible. "When an electronic medical record is printed out, the amount of repetitive data in it is ridiculous," Klein said. "Attorneys are having conferences on how to attack EMRs.
"All these cases were from top vendors. We're talking about well-established ones used at Kaiser [Permanente], at the VA... and academic institutions," Klein continued. "These are not rare cases. These are common things."
In another case, the physician was accused of plagiarizing data entered from another healthcare provider because he copied and pasted basic patient information.
Rita Bowen, senior vice president of health information management for Healthport in Atlanta, a records audit management and tracking technology firm, said she's seen duplicate data, erroneous data and copied data in EMRs.
"I've seen records where someone has copied and pasted from older records, 'The IV will be removed today,' over and over again. Well, was it removed?" Bowen said, illustrating how admins may copy and paste older information into newer records.
In fact, when it comes to strong information governance, Bowen said most healthcare facilities are woefully behind in rolling out rules and standards and ensuring they're adhered to.
But the problem isn't solely human error. The way EMRs and electronic health records (EHRs) are designed can prompt error-prone entries. For example, drop down menus for diagnoses can automatically enter data if a mouse is hovered over them too long.
"We've seen 92-year-old women getting diagnosed as crack addicts because of drop down menus," she said.
While Klein and Bowen readily defend the implementation of EMRs and EHRs as both time savers and records that increase mobility and accuracy when used properly, vendors should also be working to reduce complexity and introduce safeguards.
For example, when data is copied and pasted from one page of a record to another, some EMRs highlight that entry until an attending physician or nurse has verified it.