Patient Harm from EHRs


I’ve been educating physicians on the risks of electronic health records (EHRs) for years, including the risk of harm to patients. Now I note that The Joint Commission on March 31st issued Sentinel Event Alert 54, Safe Use of Health Information Technology, which includes examples of how adverse events may occur through the use of EHRs.

Here are just some potential patient safety problems caused by the use of EHRs –

•  Box checking – important information can be omitted if you just check the boxes
•  Drop boxes – can be very sensitive; a slight hand movement changes the entry
•  Copy and paste (“cloning”) – incorrect information is continually relied upon and it leads to so much information that providers cannot find pertinent clinical information
•  Alert fatigue – vendors want to include every possible alert, including irrelevant ones, which can lead to users ignoring all alerts, including relevant ones, which endangers patient safety
•  Default data – may or may not be accurate for a specific patient
•  Templates – they are not “one-size-fits-all”

Here’s an example of patient harm resulting allegedly from the physician’s use of the EHR from a New York case: A patient presented to the emergency department with complaints of severe calf pain and swelling. He was discharged with a diagnosis of viral gastroenteritis. Thirty six hours later, the patient died at a different hospital of necrotizing fasciitis.

The defendant physician said in a deposition that she was bound by the diagnostic system’s templates for complaints that guide doctors’ assessments and treatment plans. The court, in its opinion, addressed the templates in the hospital’s EHR and said:

“The EMR templates are directed towards the chief complaint [which the doctor chooses] that also pertains to everything, your assessment and plan at the end of the chart. Here the chief complaint chosen by [the defendant physician] was fever, even though she acknowledges that Mr. Bowman did not have a fever at the time. She indicated that she had no option regarding the use of a template: you have to choose a template, and by that choice, a screen pops up and provides the doctor with other options or choices to make. So for example, there are different templates for other chief complaints, which include, as examples, ones for chest pain or abdominal pain.” [emphasis added]

As evidenced by this case, in addition to patient harm from EHRs, there can also be physician harm, in the form of professional liability. Watch for more on this in a future post!

Donna Vanderpool, MBA, JD – Vice President
As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for The Psychiatrists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice in Virginia.

This blog has also been cross-posted on LinkedIn.