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Hidden Malpractice Dangers in EMRs

April 22, 2009
by Jim Feldbaum, M.D.
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Each morning I have pushed to my email a list of the recent Internal Medicine articles from Medscape (WebMD). When I saw the headline about malpractice dangers of the EMR I expected more fuel for my lawyer phobia. However, Steven K. Stern, Esq., a healthcare attorney with offices in five states, made a few good points:

  • Too much information: The use of templates can bury positive findings beneath volumes of pre-configured boiler plate and can therefore be more easily overlooked. He suggests that positive findings be highlighted or repeated in a separate section of the note.
  • Wrong template: He illustrates the problem with the example of a neurologist who used an adult exam template for an infant. The exam included the statement that the patient was oriented to “time, place, and person” clearly not appropriate verbiage for an infant.
  • Changing standard of care: As clinical decision support becomes more sophisticated and more widely implemented will failure to use an EMR become a deviation from recognized standards?
  • Attention to the patient: Will the task of utilizing the EMR distract the physician from the real task of attending to signs and symptoms?

Wow, not what I expected from the title. Attorney Kern made very legitimate clinical observations. He suggests vigilance when using the EMR especially if inexperienced or poorly trained. For twenty years I dictated into templates (“physical examination normal, except…”), but I dictated in front of the patient. Not infrequently the patient would correct an addition or omission. I would love to see a study on the accuracy of documentation into EMR templates.

The challenge remains for physician users of the EMR to treat it with the same respect as for any other technical instrument of care. It is also a challenge for designers to make the EMR user friendly and relevant.

Greatness is more than potential. It is the execution of that potential. Beyond the raw talent. You need the appropriate training. You need the discipline. You need the inspiration. You need the drive.

Eric A. Burns, GossamerCommons, 08-12-05

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James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...