EHR and Malpractice Liability

Background: Various opinions and concerns have been expressed in the media regarding a potential increase in liability risks associated with EHR adoption.[1] Occasional articles even brought attention to trials where EHR's were involved in the medical care.[2] There is however a very small number of studies that have been published containing and comparing actual measurable data.

A study published in 2008 [3] was performed by taking data from surveys obtained between June 2005 and November 2005 of a random sample of 1884 physicians in Massachusetts and looking up information on paid malpractice claims on Massachusetts Board of Registration in Medicine in 2007. Results showed a lower rate of paid claims (6.1% for physicians with an EHR compared with 10.8% of physicians without EHR). The study however, was limited by imprecision in the temporal relationship between EHR adoption and paid malpractice claims, statistical significance was not achieved, and it also was not clear whether the reduced rate of paid claims was due to a reduced number of claims, or a reduction in the rate of claims leading to payment. Considering these limitations, some of the authors of this study performed a follow up study [4] , briefly reviewed below:

Methods: authors merged closed claims data from a major malpractice insurer in MA for physicians covered from 1997 to 2007, with data from surveys sent to a random sample of physicians. The number of insured years was calculated before and after EHR adoption.

Results: Of the 51 unique claims identified, 49 were prior to EHR adoption and 2 were post EHR adoption. This represents a reduction of the rate malpractice claims to about one sixth of the rate observed prior to EHR implementation in the group of practices studied. This study did not account for confounding variables such as difference in practice styles (with early EHR adopters being a larger part of the analysis), or other interventions leading to lower malpractice risks. Also, results might be difficult to generalize because of the heterogeneity of medical practices and EHR implementations.

Comments: concerns can still be heard occasionally about EHR implementation increasing risk of legal liability, especially when transition from a paper system to computerized patient records is being discussed. Even with its limitations, the results of this study certainly don't support the idea that EHR implementation would by itself lead to an increase in malpractice risks. Instead, it shows, that at least for the group of physicians in the study the rate of malpractice claims was 6 times lower after the adoption of the EHR compared to before adoption of the EHR.

References:

1. Terry K. Will an EHR affect your malpractice risk?. Medical Economics [serial online]. July 6, 2007;84(13):55-58. Available from: OmniFile Full Text Select (H.W. Wilson), Ipswich, MA. Accessed August 26, 2012.

2. Neil Versel, Electronic Records May Increase Malpractice Lawsuit Risk, InformationWeek October 25, 2011, available online at http://www.informationweek.com/healthcare/electronic-medical-records/electronic-records-may-increase-malpract/231901621, accessed on 8/26/2012

3. Virapongse A, Bates DW, Shi P, Jenter CA, Volk LA, Kleinman K, Sato L, Simon SR, Electronic health records and malpractice claims in office practice, Arch Intern Med. 2008 Nov 24; 168(21):2362-7.

4. Quinn MA, Kats AM, Kleinman K, Bates DW, Simon SR. The Relationship Between Electronic Health Records and Malpractice Claims. Arch Intern Med. 2012;172(15):1187-1189. doi:10.1001/archinternmed.2012.2371.

Also see related article on clinfowiki about "E-Discovery, EHR and Medical Liability"

Submitted by Corneliu Antonescu, MD