Electronic Medical Records in Patients with Chronic Pain
Avoiding Pitfalls in Electronic Medical Records in Patients with Chronic Pain
I’m Ed Smith, a Sacramento Chronic Pain Lawyer. There is no longer a time where physicians and other healthcare providers need to dig through filing cabinets in order to find patients charts or running through the office looking everywhere for a lost chart as the patient waits to be treated. The times have changes with the addition of the electronic medical record (EMR) in the office-based setting. It is now as simple as clicking a mouse to check patients in for their visits or to tell the provider that the patient can be seen. Test results are uploaded easily from the laboratory and healthcare providers have the patient’s chart available at any time of the day or night as long as they have computer access. Electronic medical records have made the job of keeping records much more efficient.
Increased Legibility of Records
As of 2008, a study out of the Archives of Internal Medicine reported that physicians who used electronic health records were less likely to have paid out malpractice claims. Why is this the case? Increased legibility of the record and improved followup through the EMR has reduced adverse outcomes and has made healthcare providers easier to defend should a lawsuit occur. Communication between patients and their healthcare providers has become more fluid and has improved.
Electronic Medical Record Pitfalls
Are there downfalls to the use of the electronic medical record? Yes, there are some. For one thing, the templates and legibility of the documents can result in documents that are filled with pages of irrelevant, repetitious, and erroneous information. In an EMR, it is easier to track who has accessed the record and when it was accessed. It is also easier to discover what changes have been made to the document and exactly when the changes took place. This can lead to problems regarding the provider’s conduct.
For example, say that the visit with the patient took place 2 weeks before charting it on the EMR. Is it possible to really recall the patient’s complaints or the physical exam findings from that long ago? With that time lapse, it is easier to see how concerns could arise. Consider the circumstances in which a physician is supervising a nurse practitioner. Is it usual for the physician to access the charts at 2 am and only spend about 14 seconds in reviewing the chart? Did the physician actually review the chart thoroughly enough? EMRs are all time-stamped, which is a discoverable item and one that can leave a true digital fingerprint.
Ignoring Multiple Alerts
Unfortunately, the vast amount of information that the EMR now provides can become exceedingly overwhelming. Electronic prompts and alerts that flag an abnormal lab test result or indicate the potential for a drug interaction can be easily ignored. We have become accustomed to simply click through the record, which could result in missing valuable information. Prescribing medications directly through the pharmacy has become a commonplace occurrence, but with the ease with which the prescription can be generated with a click of a button can also lead to significant errors if it is done mechanically and without thought.
Defining Alert Fatigue
It has been discovered that EMRs dull the senses. The term “alert fatigue” means that healthcare providers are beginning to ignore the alerts generated by the EMR. It is too easy to be lulled into a state of fatigue and to ignore these types of alerts altogether. A single provider might receive an average of 150 alerts per day about EMR matters ranging from redundancy, suggesting dosage discrepancies or follow ups, just to name a few. With so many alerts coming forth, providers may forget to check the pertinent information before prescribing, ordering, or treating the patient. Yet, there is discoverable digital proof within all EMRs indicating that the red flag was waved.
Copying and Pasting of the Chart
Another pitfall associated with EMR use is the cloning of the medical record at the follow up appointment. When the healthcare provider copies and pastes a part of the chart or, in some circumstances, pastes the entire progress not into a subsequent visit note, it is vital that the information from the past visit be removed. For example, if the patient’s family member dies, it is often placed in the chart. If this information continually gets copied and passed, it appears as though the patient’s loved one died “last Thursday” at every visit. This creates controversy regarding the validity of the note. It is vital that charts with coped and pasted portions be thoroughly reviewed for any discrepancies at each visit and that the information be pertinent to the current visit before the record is saved.
While a lawsuit is never a welcome thing, it does occur. Malpractice insurance carriers now recommend if you are not sued to not immediately review the record as you would likely want to do. Instead, they recommend that you wait for a paper copy of the chart to be provided to you from your lawyer. The idea is that a quick review of the chart can suggest the doubt of the healthcare provider who might question the care that was given. As a provider, you may also be inclined to add or change information or enhance the record with details—all of which are discoverable.
Increase in Number of Patients
With healthcare providers seeing a greater number of patients every day, the need to use EMRs is obvious. They can be a vital tool in the efficiency of the care of the patient in the 21st century. However, along with their ease of use and reliability there are pitfalls that we must be conscious of and continually fight back against in order to provide the patient with the safest and best care possible. For this reason, it is the provider’s responsibility to make sure the most current, correct record is available.
Sacramento Chronic Pain Attorney
Member of Million Dollar Advocates Forum.
Photo Attribution: By Jerry Berger [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons