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TEMPLATE FOR DISASTER

Among the advantages being touted for adopting EMR is the claim that the malpractice risk for the physician is reduced.  After all, good records in most cases should actually help an otherwise good defense, right?  Maybe not. 

EMR proponents and vendors will very likely cite published data about how EMR both reduces medication errors and documents fully to protect against the occurrence of malpractice.  The reality is that many of these studies are relatively weak in proving their point, but slip past the editors since it is a popular topic that may be less subject to vigorous peer review. Once such example: http://doctorrw.blogspot.com/2009/01/does-emr-adoption-decrease-malpractice.html.  And anyone who has ever used an EMR can attest that medication errors are by no means fully prevented by adopting e-prescribing. More about this topic in a future column.  So it’s small wonder why websites for malpractice attorneys actually promote the adoption of EMR by physicians—it makes their job that much easier. See: http://malpracticeattorneys.net/benefits-of-emrehr-software.html

There are many legal pitfalls one needs to be aware of when transitioning to an EMR.  Witness the hapless neurosurgeon that this past week received sanctions from the RI Department of Health Board of Licensure and Discipline. According to Providence Journal accounts the doctor was using an EMR template, and by doing so, was caught documenting, and billing for, exams and procedures that he did not actually perform. A ProMutual representative once related to me the malpractice case that became indefensible when a plastic surgeon consulted for a rhinoplasty used his EMR template that documented an internal vaginal exam on his patient that he had obviously never performed (hopefully). Careful scrutiny must be paid to each note to ensure that you have not pulled up a template on a 6 month old that finds that the patient was walking and talking normally. Current malpractice attorney blogs seem to be full of anticipation on the EMR issue, and they’re just waiting to pounce. For a great overview and history of this topic, see: http://medicalexecutivepost.com/2010/05/17/soapier-emrs-%E2%80%A6-beware-the-alphabet-soup-switcher-roo/

In my own experience, the majority of these template errors will probably occur within the first six months of EMR adoption when the physician is new to system and is relatively disoriented as to how things work. The physician is way too busy keeping up with the necessary documentation to notice the errors that may be creeping in. We definitely need more awareness and support on this vital issue from those companies assisting physicians in implementing EMRs. More about this problem also in a future column.

The flip side of the coin is a policy of minimal documentation that I’ve noticed being used by some colleagues. In the instances I cite, the physicians had previously documented quite well on progress notes prior to instituting an EMR.  But now we have noticed a PROGRESSIVE decline in standard documentation items that simply get left out of the EMR progress note, presumably so that these physicians don’t have to deal with as many template errors and their associated liabilities.  It becomes difficult to understand what was done at the encounter, let alone understand the doctor’s thought processes. Is this really good medicine?  Hell NO!

Further (disturbing) reading is available at:

• http://www.medscape.com/viewarticle/589724
• http://www.khorrami.com/newsletters/news_october09.html
• http://www.mdpcelaw.com/media/documents/Nov06MedMal_SI.pdf