Successful resolution of a medical malpractice case often hinges on the quality of the medical record. Electronic medical records are dramatically affecting the understanding of what transpired.

Advantages of Electronic Medical Records

An electronic health record (EHR) brings together legible information about a patient collected from outpatient and inpatient settings. It is ideally available from any setting where the patient may receive care, such as an emergency department, hospital or clinic. For this to happen, systems need to be integrated and built on a common platform.

An electronic medical record contains information from one provider, such as a physician’s office or a hospital admission.

Electronic health records allow providers to immediately access and share information, reduce duplicate testing and provide information more readily within a facility.

Recognizing the savings and efficiency associated with electronic medical records, both President Bush and President Obama supported legislation to encourage adoption of electronic medical records. Financial and legislative incentives spurred rapid adoption of electronic medical records in both inpatient and outpatient settings

Electronic medical records have many advantages. They are more than automated paper records; they take advantage of the unique ability to use drop down menus, collate data from monitoring equipment, and avoid having to write long free form notes.

The use of computer technology to prescribe medications, in combination with other software applications, is a means of decreasing medication errors. Barcode scanning of medications at the bedside helps to assure that the right patient receives the right medication. EMRs allow the nurse to enter the information once and re-use it many times. Data entry may be driven by the patient’s care plan, policies and procedures, standards of care, and patient safety.

EMRs minimize the risk of lost information, which may occur if a handwritten chart or handwritten papers are mislaid. Each person who enters information in the record is identified by name, eliminating the need to guess at the identity of the author of the entry.

Electronic medical records promote patient safety through the use of alerts, prompts and timely transfer of test results. They are legible, which replaces the labor-intensive task of transcribing orders or contacting providers asking for clarification of illegible handwriting.

Electronic medical records can promote standardized documentation when used with templates. Nurses don’t need to remember the important elements of care to the document; the software prompts them to enter the data. EMRs are useful for generating work lists to help nurses organize and prioritize their time.

Patient monitoring equipment may feed data directly into the electronic medical record, thereby eliminating the need to manually input it. They may incorporate built-in safety mechanisms and clinical alerts, although providers must pay attention to them for them to be effective.

Staff Ignore Electronic Medical Record’s Warning

For example, a nephrologist wrote a prescription for potassium for a woman who was on dialysis. The order was not clear. Originally, he wrote it as 10 meq and then changed his mind and attempted to write a 2 over the 1. The hospital computer provided a notation for the need for confirmation. The nurses and pharmacists misinterpreted the order and believed it was 120 meq, which was a fatal dose. The nurse started an infusion of 120 meq. The woman died four hours later. The hospital settled for a confidential amount before trial.

At trial, the plaintiffs argued that the physician set the chain of events in motion, although the nurses and pharmacists should have recognized the error. The physician admitted that the prescription was not clearly written but argued that it was unforeseeable that such a high dose would be administered without being questioned. The hospital’s computer had tagged the potassium order for confirmation, but it was not confirmed.

The defendant also argued that the patient had a limited life expectancy of six to twelve months.

The defendant pointed out the orders for “do not resuscitate” and “do not intubate” were in place. The jury assigned ninety percent of the fault to the hospital and ten percent to the physician and awarded $379,122.39.

The verdict was reduced to $37,912.24. (Martha G. Garcia, Judith Rocha, et al v. Baptist Health System, d/b/a VHS San Antonio Partners L.P. d/b/a Northeast Baptist Hospital and Flavio Alvarez MD, reported in April 2014.)

Research has focused on how nurses’ benefit from electronic health records by improving nursing documentation, reducing medical records, and improving legibility. Do electronic medical records improve patient outcomes?

A University of Pennsylvania study found that nurses from hospitals with fully implemented electronic health records were significantly less likely to report unfavorable outcomes compared to nurses working in hospitals without fully implemented electronic health records.

The outcomes included less frequent medication errors, improved quality of care and confidence that the patient was ready for discharge, and an increased emphasis on patient safety. There were fewer incidences of things being overlooked when the patient was transferred between units.

Audit trails permit investigation of how the electronic medical record was generated and viewed.

This information may be essential in a lawsuit and could affect determinations of whether the provider followed the standard of care. It is difficult to determine if a healthcare provider picked up a handwritten chart and looked at it. There is no tracking system that creates a log of such activities.

However, EMRs provide accurate logging of healthcare providers who accessed a medical record. This may complicate the provider’s defense.

Neurosurgeon did not open Electronic Medical Record

In a case, the EMR showed a healthcare provider did not view medical records. A sixty-four-year-old man involved in a car collision was taken to Suburban Hospital. He complained of right arm weakness, left shoulder pain, right-hand weakness and neck pain.

A CT scan showed a neck fracture, but it could not be determined if it was the collision or from a neck injury the patient had as a teenager. The trauma surgeon ordered a neurological exam and instructed a resident to see that it was performed. The resident told the trauma surgeon he had spoken to the neurosurgeon; the trauma surgeon said the patient could be discharged if he was “at baseline”.

The plaintiffs claimed the neurological exam was not performed. The neurosurgeon testified during the trial that he was not called to see the patient. The defendants claimed the neurological consultation occurred but was not documented. The plaintiff argued there was no record of the neurosurgeon even accessing the patient’s medical records.

A nurse performed some testing on the patient and determined he was “close to baseline” but did not examine his right arm and hand. The patient was discharged a few hours after arrival and woke up the next day paralyzed from below his mid-chest.

An MRI showed a large, herniated disc which was caused by the collision. Despite emergency surgery, the patient remained paralyzed.

The plaintiff alleged negligence in the failure to have a neurosurgical examination, as was the hospital’s policy for persons with spinal fractures.

The jury returned a verdict of $3,587,687.44. (Buttrey, et ux v. Suburban Hospital et al, reported in August 2014).

EMRs offer some significant advantages in the clinical care of a patient and in the reconstruction of events in a lawsuit. Part 2 covers some of the disadvantages.

What do you think of EMRs? Love them? Hate them? Add a comment below.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.