Electronic Medical Records Disadvantages

Ask a legal nurse consultant or attorney about using electronic medical records in litigation and you are likely to hear groans. Many medical records contain volumes of data and very little information. The product we get to work with may:

• Contain the same information printed multiple times.
• Provide nursing documentation in random order.
• Have an abundance of checklist data and no narrative notes.
• Contains no information about a change in the patient’s condition.

From the physician office or healthcare facility’s perspective, electronic medical record systems are expensive to purchase and implement, with large investments in training and maintenance. The system has to be reliable and protected from power outages, electrical storms, and air conditioning failures. Information Technology employees must be available to troubleshoot and restore a system that has “gone down” or become inoperable. Nurses and other clinicians need to create a manual record and then re-enter data into the electronic record once the system is restored.

Until electronic medical records are fully integrated, there will be inefficiencies and lack of information with redundant testing and data entry.

While a drop-down menu organizes information about the patient, the choices may not accurately capture what the nurse wants to document about the patient. Misinformation about a patient is easily disseminated and difficult to eradicate. A nurse may get into a pattern of rote clicking of fields and thus enter information that is nonsensical.

EMR nonsensical entries
Consider these real entries:

• The call bell was within reach of a woman with contracted arms and who was in a coma.
• The nurse recorded she gave hair care to a man who was bald.
• A nurse documented a man, who was a paraplegic, was walking in the hall.
• A nurse documented a woman who was NPO consumed 100% of her breakfast.
• A nurse documented a patient who was incontinent was voiding without difficulty.
• A physician documented he explained to a patient that she should call the office if she developed fever, redness of her incision or death.

Research on EMR Errors

Recent studies focused on additional drawbacks of electronic medical records. ECRI Institute compiles a database of patient safety events. With more than 300,000 event reports, ECRI is in an ideal position to spot trends.

One of the top 10 concerns is data integrity failures with health information technology systems – errors caused by electronic medical records. An insurance company called CRICO collects data in a large database of 275,000 open and closed claims.

In a study released in 2014, it found 147 cases in which electronic health records were a contributing factor in a year’s worth of medical malpractice claims.

Nurses use text messages and emails to contact physicians or notify them of pertinent clinical information. This raises questions about how that information is safeguarded and incorporated into the medical record.

Software designed without input from nurses may result in cumbersome, user-unfriendly programs that do not build on the workflow and clinical processes nurses’ use.
Consider how the plaintiff asserted the nurse should have used the electronic medical record in this case:

EMR and Nursing Malpractice Suit

In Pilarski v. Huran Valley-Sinai Hospital, Inc reported in August 2014, the plaintiff had a history of back problems and went to an orthopedic spine surgeon for an elective lumbar decompression surgery.

After surgery, the post-operative hospital nurse found an order under “activity” for weight bearing as tolerated and stood the patient up for three minutes unassisted. He allegedly stumbled. There was an order written later in time for “absolute bed rest.”

After the patient was discharged, he was readmitted five days later with constipation, incontinence, urine retention, and pain. An MRI of the lumbar spine revealed an epidural hematoma compressing the cauda equina nerve roots. The plaintiff claimed this hematoma was caused by the nurse standing him on the day of surgery.

The plaintiff contended that the hematoma caused permanent nerve injury and resulted in the bowel, bladder, and sexual dysfunction.

The plaintiff argued that the EMR reflected that the order for bed rest was several orders removed from the weight-bearing order in the chart. The plaintiff claimed that the nurse was required to scroll through all of the orders. The defendant claimed that the order category of “activity” is the only place where the nurse was required to look for post-operative movement orders and that the three-minute period of standing was not enough to cause the injuries alleged by the plaintiff. The hospital maintained the plaintiff’s injury was related to the surgery. The jury returned a defense verdict.

Electronic medical records the improved since they first became available for documentation, (see part 1 for the advantages) but the product legal nurse consultants, experts, and attorneys receive is often cumbersome and frustrating to use in litigation.

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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.