This post is courtesy of The Pathology Blawg, a blog that deals mostly with medicolegal issues in the practice of pathology and medicine.
As all physicians know (or should know, anyway), there is a significant push at the federal level to move from paper record-keeping to electronic record keeping in health care. While some forward-thinking physicians and hospitals have pursued EMRs before the federal push, widespread adoption of EMRs has faced significant skepticism for multiple reasons, including cost (even though federal subsidies will be available), complexity, fear of change, neo-Luddism, medical liability, poorly designed EMR packages in the private domain and others.
A recent study has just been published in the Archives of Internal Medicine that looked at both closed claims from a single large malpractice carrier in Massachusetts from 1995-2007 with data from a survey of random physicians both before and after EMR adoption.
The authors found that the rate of malpractice claims after EMR adoption was 1/6th the rate seen before EMR adoption, with an estimated relative risk of 0.16 (95% CI 0.04-0.71).
That is a significant reduction. While this study was limited by its size and the fact that it only included data from one insurance carrier, the study is interesting nonetheless. Because it looked at closed claims and not just claims with payment, the authors suggest this study indicates that fewer medical mistakes were made. Some skeptics of EMRs worry that the technology will lead to more errors, not less.
I'm not sure I can make the direct leap that fewer malpractice claims equals lower errors, as the reasons why people file malpractice claims are often independent of whether an error occurred or not. For example, as I posted about a few days ago, the mere presence of tort reform legislation, as Massachusetts has, that caps non-economic damages, can have a chilling effect on the filing of malpractice claims.
It should be noted that while Massachusetts does have tort reform on the books that limit non-economic damages to $500,000, Massachusetts provides an exception that is often exercised, thereby essentially negating the effect of the cap in the first place.
Clearly more research on this topic will need to be done over a broader geography, but in my opinion, this study can at least be viewed as encouraging in the fact that no increase in malpractice claims following EMR adoption was seen in the group studied.
via Reuters:
(Reuters Health) – Doctors using electronic health records are less likely to get sued than their colleagues who use traditional paper records, a new Massachusetts study showed.
The technology is being adopted by U.S. medical practices to decrease errors and streamline patient care and is an element on which President Barack Obama's healthcare overhaul has focused.
Some researchers have expressed concern that when using new, unfamiliar systems doctors could make more mistakes, such as writing notes and prescribing drugs in the wrong patient's record.
"While there's a general belief that they're helpful … there's also been concern that these same systems can predispose to unrecognized types of (errors) and unsafe events," said Dr. Steven Simon of the VA Boston Healthcare System.
Simon and his colleagues found that using electronic health records (EHR) was tied to an 84 percent lower chance of getting sued. Their study was published on Monday in the Archives of Internal Medicine. bit.ly/QceVBj
"If nothing else, these results should be reassuring to physicians and to practices that there's a very, very little chance that EHRs and EHR adoption would increase their chance of malpractice claims," Simon told Reuters Health.
One researcher not involved in the study cautioned that doctors may have to wait to see the longer-term effects of electronic records on malpractice lawsuits, including whether the technology allows more medical decisions to be scrutinized in court.
Simon estimated that about one-third of U.S. practices are currently using electronic health records, which allow different doctors treating a single patient to access each other's notes and see what medications have been prescribed.
More advanced systems warn doctors if they are about to prescribe a drug that may interact with other medications a patient is taking.
IMPROVING QUALITY OF CARE
For the study, Simon and his colleagues surveyed 275 Massachusetts doctors in 2005 and 2007 about if and when they had adopted electronic health records and compared that to medical malpractice claims against those doctors starting in 1995.
Thirty-three of the participating doctors had been sued. The researchers calculated 49 claims before electronic records were adopted, including 13 resulting in a payment, and two claims after, neither leading to a payment.
"Electronic health records in general tend to improve the quality of care by decreasing the number of mistakes, and to the extent to which mistakes drive malpractice claims, you should be seeing less claims," said Dr. Sandeep Mangalmurti, who has studied health technology and malpractice at the University of Chicago.
Still, he said, there might be a period while the electronic records are being introduced that more mistakes could happen.
"There's no question there are kinds of errors that get introduced, and they're solvable," said Dr. Brian Strom, who has also studied electronic health records at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
"We need an iterative process that develops the product, identifies the errors, fixes the errors and keeps testing," said Strom, who was not part of the research team.
Mangalmurti said in the long run, lawyers may use data from electronic health records in court, which could also make doctors more vulnerable to malpractice lawsuits.
"Suddenly there's a lot more information available for scrutiny," Mangalmurti, who was not involved in the new study, told Reuters Health. "Everything a physician does is now theoretically accessible by everyone." (Editing by Christine Soares)
