Malpractice 'Discovery' Dangers in Your EHR








"They send somebody in and get rights to look at the computer records, assuming the printout doesn't have as much as is in the computer," says Sterling. "When I go in to a physician's EHR system, I can go look at all kinds of things and make any comparisons in record-keeping or care."


What Types of Liability Problems Could the EHR Cause?


Customization. "A lot of systems have setups and customization tools that doctor might want to use. If the doctor is using them, the plaintiff attorney may ask, 'What was the clinical basis for the change, and how did you verify that the EHR properly accepted your change? Explain to us why you set it up to do certain things that caused these other issues to occur.'"

Design issues. The design of the screens or capture and populating of information could also lead to problems. "Some systems do or don't consider phone messages as part of the patient's medical record. In other systems, you have to actively choose whether messages will be considered part of the record," says Sterling. "You might have to defend any of your decisions about the EHR or its features. If the product doesn't include messages, you may be unable to prove your due diligence in dealing with the patient's problem."




Check boxes. Some systems allow the physician to check off a box on the basis of what should have happened during the visit. "The plaintiff's side will look for information to support whether the doctor did everything he said he did. Is the information available in the system, and does it support what the doctor said he did at the visit?" said Sterling.








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