Causes of EHR-related Pediatric Malpractice Claims

The days of squinting while trying to read the physician’s prescription are long gone along with the bulky files which stored all our medical records.  The electronic health record (EHR) has replaced the pen and paper documents, resulting in better legibility and documentation of our medical records.  A powerful tool that is helping physicians achieve better care, lower costs per capita and better population health.  But, like all good things, the EHR is also prone to causing errors – errors that can be a source of medical liability.  Let us look at some of the factors that can be the cause for EHR related malpractice claims at a pediatric setting.

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Interoperability Issues

Office based pediatricians use of EHR rose from 58% in 2009 to 79% in 2012.  However, interoperability issues caused due to multiple EHR systems and platforms coupled with limited pediatric functionality still prevail.

There is a need for pediatricians to realize that due to these interoperability issues, they do not have access to complete data on hospital admissions, emergency department visits, lab results, subspecialist reports and care provided outside the medical facility.  Serious errors in medical management could result due to these fragmented EHRs, resulting in harm to patients and exposing pediatricians to professional liability through malpractice claims.

Electronic Prescribing

While nearly 50% of pediatric practices are transmitting prescriptions directly to the pharmacies through the electronic prescription programs, the lack of pediatric functionalities in many EHRs can pose significant safety risks to children.  There is a need to verify if the EHR uses pediatric-specific drugs, calculates the correct pediatric dosages, and alerts the provider of dosing errors and potential contraindications.  Another problem area is that the majority of e-prescribing programs do not keep information from providers using a different e-prescription program. This can lead to serious consequences for both the patient and the pediatrician.

Cloning

While copying and pasting information from previous medical records does reduce time and effort to duplicate records – it can also cause tragic results.  Also known as cloning, duplication more often than not, results in over-documentation of the actual findings – for example, when the document cites items that have changed or were not examined in subsequent visits.  This can lead to damaging the credibility of the record in a liability action for the pediatrician.  For the patient, incorrect information from a past visit can lead to incorrect care.

Validating Reports

It is important that electronic reports from labs and consultation are examined by a provider before being incorporated in the EHR.  Incorrect reports or posting the wrong one can lead t serious medical errors and pose a significant malpractice risk.

Transition, Retention, Contracts

While it is good to move with the times, care should be taken when transitioning from paper to electronic charts. Before getting rid of the old paper records, pediatricians need to be sure that they have complied with all federal and state record retention laws.

Before finalizing the provider, all EHR vendor and service contracts should be scrutinized and legal review secured.  Pediatricians need to be aware of where protected health information is stored and the relevant risk of loss of this data.

Coding Issues

Some EHRs may be prone to coding pediatric services at a higher level than warranted due to a feature that automatically calculates CPT codes based on the services documented in the EHR.  Incorrect coding can lead to receiving overpayments, which may lead to liabilities due to fraud and system abuse.

The majority of pediatricians using EHR find the advantages outweigh the disadvantages.  Although, adverse EHR events are rare, they do exist. Becoming aware of and preventing potential and real risks of EHR errors is the best policy.


Reference

  1. Anunta Virapongse, M. M., David W. Bates, M. M., & Ping Shi, M. (2008, November 24). Electronic Health Records and Malpractice Claims in Office Practice. Retrieved from The JAMA Network: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/414653
  2. Graber ML, S. D. (2015, November 6). Electronic health record–related events in medical malpractice claims. Retrieved from PSNet: Patient Safety Network: https://psnet.ahrq.gov/resources/resource/29582/electronic-health-record-related-events-in-medical-malpractice-claims
  3. Richard L. Oken, M. F. (2016, August 8). Lessons learned from EHR-related medical malpractice cases. Retrieved from American Academy of Pediatrics: http://www.aappublications.org/news/2016/08/08/Law080816
  4. Spooner, S. A. (2007, March). Special Requirements of Electronic Health Record Systems in Pediatrics. Retrieved from American Academy of Pediatrics: http://pediatrics.aappublications.org/content/119/3/631
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Statistics on Orthopedic Malpractice Cases

Medical malpractice is a poorly understood and complex phenomenon.  Which patients file claims, why these claims are filed, and under what conditions remain vexing questions.  In 2014, malpractice lawsuits were filed against 18% of orthopedic surgeons by patients and their families.  According to a 2011 study, orthopedics is the fourth most sued specialty, after neurosurgery, cardiothoracic surgery, and general surgery.  There are several aspects of orthopedic malpractice claims that intuitively appear to contribute to malpractice losses.  Among these factors are the nature and quality of the physician/patient relationship, the amount of time physicians spend communicating with patients, and the presence, or at least the appearance, of physician empathy and compassion.

The Doctors Company recently released a closed claims study examining medical malpractice claims against orthopedists.  Covering 1,895 claims against orthopedists that closed between 2007 and 2014, including all claims and lawsuits in which an orthopedist was named a defendant; the study included all cases regardless of the outcome in order to get a broader sense of what motivates a patient to pursue a claim and to gain a better understanding of what led to patient harm and the respective system failures.

According to David B. Troxel, MD, medical director of The Doctors Company in Napa, California, the nation’s largest insurer of physician and surgeon medical liability, “if you practice orthopedic surgery long enough, the odds are good that someone will hit you with some sort of lawsuit.”  The good news is that the rate of lawsuits has been declining across all specialties since 2008, added Dr Troxel. However, according to him, far more liability suits could be prevented if orthopedists took the time to maintain good relationships with their patients.

The study analyzed claims against more than 2100 orthopedists, pinpointed the most common types of claims and, based on these findings, developed recommendations for avoiding them.

Given below are some of the important statistics from the study.

  1. 46% of claims came from patients stating their surgery was performed improperly, making this the largest reason for filing claims.  While the allegation was most often made when the outcome of the procedure differed from the patient’s perspective, the findings of expert reviewers showed only a small percentage of injuries were due to substandard care.
  2. The procedures that brought the maximum and most frequent allegations of improper care were total knee replacement, total hip replacement, knee arthroscopy, vertebroplasty, open reduction internal fixation, discectomy, exploration and decompression of spinal canal, shoulder arthroscopy and rotator cuff repair.
  3. 16% of all claims stemmed from improper management of surgical patients, with patients claiming improper management if they experienced infections, continued pain or mechanical complications of orthopedic devices or mal-union or nonunion of bones.
  4. 13% of claims were due to delayed, failed or wrong diagnosis with compartment syndrome, fractures, nonunion of fracture, hematomas, postoperative infections, malignant bone tumors, thromboembolism and dislocations accounting for the most incorrectly diagnosed procedures.

The study also identified several factors that contributed to patient injury.

  1. 35% of all patient injury was due to technical performance, although that does not necessarily imply negligence.  While most claims were related to known risks, a “small” portion was due to substandard care.
  2. 29% of patient injuries stemmed from patient behavior wherein patients dissatisfied with the care provided sought other providers thus reducing the original physician’s opportunity to address concerns or the unsatisfactory surgical outcomes through follow-up care.

References

 

  1. Harrison, L. (2015, October 7). How Orthopedists Can Get off the List of Most-Sued Doctors. Retrieved from Medscape: http://www.medscape.com/viewarticle/851706_2
  2. Oliver, E. (2016, August 11). 10 thoughts and statistics on medical malpractice claims against orthopedists. Retrieved from Becker’s Healthcare: http://www.beckersspine.com/sports-medicine/item/32668-10-thoughts-and-statistics-on-medical-malpractice-claims-against-orthopedists.html
  3. Peckham, C., & Grisham, S. (2016, January 22). Medscape Malpractice Report 2015: Why Orthopedists Get Sued. Retrieved from Medscape: http://www.medscape.com/features/slideshow/malpractice-report-2015/orthopedics
  4. Sonny Bal, M. M., & Lawrence H. Brenner, J. (2008, April). Surgeon characteristics and medical malpractice: Are orthopedists at risk? Retrieved from Healio Orthopedics Today: http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7Bc033311f-cb7b-4d01-bc35-a69a36c2c5a2%7D/surgeon-characteristics-and-medical-malpractice-are-orthopedists-at-risk