6 EHR pitfalls physicians should watch out for to avoid 'legal misadventures'

Brian Zimmerman - Print  | 

While the integration of EHRs into America's health system aimed to advance the practice of good medicine and improve patient safety, the technology's rapid adoption occurred with little insight from providers, causing unforeseen shortcomings that have compromised productivity and the patient-physician relationship, according to a commentary article published March 7 in Anesthesiology News.

In the commentary, Peter Papadakos, MD, a professor in the department of anesthesiology at the University of Rochester (N.Y.) Medical Center, argued the implementation of EHRs was mainly carried out to aid in the transition from the fee-for-service model to value-based care, rather than to optimize productivity. Dr. Papadakos believes the key to resolving these issues is provider education.

"Medical providers at all levels need to gain exposure to digital training along with their traditional education in pharmacology, physiology and physical diagnosis," Dr. Papadakos wrote. "Human-to-technology interfacing should have a major role in training providers to recognize, evaluate and correct faults in computer records, guarding against errors and increasing patient safety, which could prevent legal misadventures."

Here are six EHR pitfalls providers should avoid.

1. Beware the drop-down menu. The drop-down menus offered on most EHRs to help physicians write medical notes can be problematic, according to Dr. Papadakos. These menus are designed to auto-populate medical notes with details about a patient's condition, but if they're not used properly, these menus could fill the note with misinformation. To avoid this issue, Dr. Papadakos said providers should take the time to free-write medical notes. This practice will come with the added benefit of getting the provider to focus on patient data that may otherwise be glossed over.

2. Copy and paste with caution. Copying and pasting patient notes from day-to-day can result in inaccurate information and discrepancies between notes from different providers caring for the same patient.

"Defense experts can question whether the physician had done a complete assessment because his/her progress note from the most recent visit appeared to be identical to the progress notes for the three previous days, including the same information along with identical spelling errors, suggesting that no original evaluation had been generated," Dr. Papadakos wrote.

3. Watch out for autofill when filling prescriptions. Errors can occur when prescribers go to fill a prescription in the EHR and the system offers an autofill for an entered prefix of the drug name. In the commentary, Dr. Papadakos relayed the story of a physician who meant to order Flonase, but "typed 'FLO' in the medication order screen. The EHR automatched Flomax, and the physician, without thinking, clicked on it." The patient filled the prescription and later presented to the emergency department with dizziness.

4. One error can become many with template documentation. Papadakos also detailed a claims study in which a hand surgeon evaluated a left ring finger injury, but accidentally clicked right on the EHR, which resulted in a right finger injury being reported throughout the note. Weeks later, the physician corrected the note, but the EHR documented the "original keystrokes and the changes made weeks later, thus converting an error to a level of improper legal behavior documenting fraud," according to the commentary.

5. Watch out for bulk cosigning. At academic medical centers, staff can forward many notes and consults to attending physicians for electronic signature, which can result in the bulk signing of these documents. Dr. Papadakos detailed a hearing involving a physician who signed 200 notes in 15 minutes from his vacation home. In these instances, physicians may not fully evaluate individual patient records before bulk signing documents, which could threaten patient safety, according to Dr. Papadakos.

6. Double check written records during EHR conversion. The conversion of written health records into the EHR can result in many documentation errors. Dr. Papadakos cited an error where a Tourette's patient's prescription dose was accidentally converted from 0.5 milligrams to 5.0 milligrams.

"The patient had several side effects, including cough, weight loss and not feeling well," Dr. Papadakos wrote. "All of this could have been prevented by double-checking the old data, and if the pharmacy had contacted both the patient and the office regarding the manyfold change in dosage on the prescription — something you would expect in this digital world of data exchange."

More articles on EHRs: 
Viewpoint: What teams should consider when training to use an EHR 
EHR vendors stock report: Week of March 12-16 
Cerner-VA contract update: Rollout will span 48 waves & 4 more things to know

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