By Glenn Day
Electronic Medical Records (EMR) technology was supposed to solve issues like the famously illegible handwriting of doctors. But in a lot of respects, EMR errors due to the technology’s cut and paste function has become today’s iteration of yesterday’s illegible handwriting.
The ability to cut and paste is not inherently problematic. The majority of EMR solutions save time and create a portable database of the patient’s information that is safer and more comprehensive than paper records.
But the cut and paste function has created a new problem. In fact, it’s resulted in a new term: e-iatrogenesis. It’s called the most “critical unintended consequence of Computerized Provider Order Entry” and defined as an adverse medical event stemming from cut and paste.
Here’s how it happens. Records can get convoluted and messy as events and conditions recorded by multiple medical team members on Day 1 of a patient’s hospital stay are copied and pasted onto Day 2 with another sentence or two or more added with each doctor’s assessment or nursing staff notes. And then it starts all over on Day 3.
It’s so prevalent that 82 percent of all residents’ notes and 74 percent of all attending physicians’ notes involve cutting and pasting. A recent study found that over half of its respondents had reported EMR-related claims, and 70 percent of those involved misuse of the cut and paste function.
So much detail can be added to patient records thanks to cut and paste that it can become overwhelming to review. The typical healthcare provider response is to skim through it quickly. Mistakes are made and patients suffer as a result. The financial and legal liabilities take off from there.
From a risk management perspective, you have several options to help you offset the downsides of EMR errors. Among them:
- Turn off your EMR system’s cut and paste function. This is an unusual but effective way to blunt abuse.
- Develop and communicate policies and procedures that specify how and when the function should be used.
- Provide education on the proper use of cut and paste and mandate that everyone participate – even physicians, who may be the biggest culprits. Simulation training might also be helpful.
- Consider using a voice-activated dictation system that interfaces with your EMR system. This is not commonly used because of the expense.
- Look into software that minimizes cut and paste functionality.
- Audit your EMR system regularly, and do it manually. This makes it more time-consuming but it is a more effective way to uncover issues, like chronic misusers. This is the recommended route to take if a patient suffers an adverse event that is linked to cut and paste issues with their medical record
Electronic medical records have proven to be a necessary boon for the healthcare industry with greater efficiencies, enhanced portability and other benefits. But that doesn’t negate the need for a higher level of monitoring, auditing and control to better manage the risks of improper use.
HUB International’s team of healthcare specialists is ready to help your practice assess its risks and ensure that your medical malpractice coverage is sufficient for today’s conditions.