Medicolegal pitfalls of EMRs

“EMRs (electronic medical records) have the potential to increase patient safety, improve outcomes, and create legible, accurate records, but, unfortunately, they also have the possibility of doing just the opposite,” said Herschel Lessin, MD, Children’s Medical Group, PLLC, Poughkeepsie, New York.

In the session “Help! My EMR threw me under the bus! How to reduce medicolegal risks from EMRs,” held Saturday, October 26, Lessin reviewed EMR-associated legal pitfalls, which he said are “myriad.”

“The systems are designed horribly for pediatricians,” he explained. “There’s a handful of pediatric-specific EMRs, but the vast majority are designed for adults and have little or no relevance to pediatrics.”

Lessin asserted that one of the specific problems is that templates often carry forward data not specifically discussed with patients. He explained that if a physician checks off “exam normal,” numerous other subcategories automatically show checked boxes, suggesting that the physician asked every question in every category, when that may not be the case.

Another problem is “alert fatigue.” He illustrated, “Whenever I prescribe a drug, numerous alerts pop up, most of which are useless, so physicians start ignoring all alerts. It’s like the boy who cried, ‘Wolf!’”

He maintained that many physicians over-rely on templates and boilerplate information, much the way people over-rely on spell-checkers.

“I’ve seen 8 pages of notes for a well-child visit,” Lessin commented. “It’s like playing, ‘Where’s Waldo?’ You have to go through page after page of useless boilerplate to find that single piece of useful information.”

“EMRs turn a patient narrative into a long list of checked boxes, which is not the way we need to think about patients.” He said the only solution is to completely customize all templates used.

Other measures physicians can take to help protect themselves include locking down patient files within a day or 2 of collecting information. Lessin explained that leaving charts open for longer periods is likely to raise suspicion of alteration.

He also advised to be aware of laptop and password security, and to remember that everything entered into the system has a date and time stamp attached, which becomes part of an audit trail that is subject to discovery during legal proceedings.