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  • Medical informatics and malpractice liability

    In another thread, the member named Kursk, asked my opinion on the issue of such medical informatics issues such as CPOE and e-prescribing insofar as they related to adverse outcomes and malpractice liability.

    Of interest, today's New York Times has a related article on the reluctance of hospitals to adopt EMRs or other types of healthcare IT. In a nutshell, the reasons for such reluctance are cost; little if any, calculable return on investment, and the reluctance of the medical staff to use it. Make careful note that the attending medical staff is often the most important factor in whether a system implementation is successful or not. The article can be found here: http://www.nytimes.com/2004/04/06/te...rint&position=

    There is a reputable body of literature currently out there that demonstrates that CPOE can reduce some types of medication errors, particularly in teaching hospitals. Clinical decision support tools, such as drug databases like ePocrates or the like can also reduce some types of medication errors. Bar coding medications and patients and using a centralized patient information system can reduce medication administration errors.

    Unfortunately, it can be difficult to come up with statistics showing that the use of these healthcare IT technologies reduces malpractice liability or eventual malpractice payouts. I have been doing malpractice defense\risk management for 21 years now, and in my heart, I am convinced that there is a reduction; although it is probably small and I cannot quantify it.

    In the ambulatory arena, there are many fewer healthcare IT products available, and thus very little data showing favorable results on patient care. I remain convinced, however, that if we used ePocrates or other decision support tools in conjunction with some e-prescribing tools, there will be a decrease in certain types of medication errors in the ambulatory area.

    I am very skeptical of the vendors pushing EMRs or other healthcare IT products in the ambulatory arena who state as a selling point that your malpractice liability will dramatically reduce, and thus you should get a reduction in your malpractice insurance. Not one vendor has yet been able to produce any data or a reputable journal article that supports that. And so far, the insurance actuaries at Tillinghast Perrin (who set the malpractice premiums) are not convinced.

    The fact remains that using an EMR, CPOE or other types of healthcare IT makes not a whit of difference in the adverse patient outcome and malpractice liability caused by the surgeon clipping the CBD during a lap chole, the family doc not recognizing the bad decels on the fetal monitor strip, or the internist misdiagnosing the lung cancer as bronchitis.

    So although healthcare IT has much potential to reduce errors in some limited aspects of patient care, it is not a panacea, and I don't expect there will be across-the-board dramatic reductions in adverse outcomes and malpractice liability. Now when healthcare IT advances to the level of the Emergency Medical Hologram on Voyager, look out!

  • #2
    Michael, the NYTimes link requires registration, was this article posted anywhere else?
    Mel
    There is no place like 127.0.0.1

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    • #3
      Not that I have seen yet. It was written by a NYT reporter, so unless it gets picked up by a wire service or another paper, you may only be able to read it there.

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      • #4
        ML: Thanks for the reply. I was not ignoring you but somehow I missed this thread completely. Very insightful and a real benefit to have someone in your position to post here. I agree that EMR/CPOE has been sold as a panacea and has done nothing to set proper expectations for patient outcomes, nor educate patients about what risk means. It means some people will be hurt or die no matter how carefully we apply treatments. Patient's (and our legal system) don't want to understand that.

        In the same light, first and second generation ("the documentor") EMRs are just that - early generation products. Legibility reduces some errors but bad thinking and administration errors lead to many more errors. A perfectly readable bad med order is still a bad order. But given the delays in getting to generation II, I am not sure when or if we will have the advanced AI needed for gen 4-5 ("the mentor").

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        • #5
          CPOE or computerized systems would certainly have caught the OD of chemo given to the reporter in New York.

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          • #6
            7% admissions with med errors, 66% not caught, 25% of those result in adverse event

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            • #7
              EHRs certainly can reduce errors, whether that translates to lower premiums is another thing, 'wish they did, when you have a fire & burglar alarm, your home insurance premiums go down a tad

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              • #8
                true but when a your wife has a hysterectomy which reduce the chances of more childbirth to zero your rates dont drop..

                Insurance carriers hav no interest in dropping rates.. Whatever happens will have to come from this side of the isle..
                its easier to get and not give back... LOL

                I also wonder if EMR could actually cause your rates to rise because the documentation / paper trail is more accurate so in the case of a gross failure you have created more evidence ..?

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                • #9
                  Originally posted by ozzie
                  also wonder if EMR could actually cause your rates to rise because the documentation / paper trail is more accurate so in the case of a gross failure you have created more evidence ..?
                  Our carrier gives a 5% discount if you have an EMR that passes their checklist. I think the reduced liability is the automatic tracking system for yearly mammos and followup visits for chronic illnesses and for following up on ordered tests.

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                  • #10
                    thats a step in the right direction

                    Originally posted by hirschr
                    Our carrier gives a 5% discount if you have an EMR that passes their checklist. I think the reduced liability is the automatic tracking system for yearly mammos and followup visits for chronic illnesses and for following up on ordered tests.
                    Wow that is really great
                    That's words I am very happy to eat..

                    do you have more details etc or where I can get more info and I would want to be sure the FreeMED has whatever is needed to get the discounts..

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                    • #11
                      Our carrier, ISMIE in Illinois, has a checklist but the link is in the member's only section so I can't post it. Call your carrier and ask them if they have such a plan. (We can also get 0.5% discounts for attending seminars about risk-management and doing some CME booklets that they publish. I've cut 6.5% off my payments.

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                      • #12
                        Originally posted by hirschr
                        Our carrier, ISMIE in Illinois, has a checklist but the link is in the member's only section so I can't post it. Call your carrier and ask them if they have such a plan. (We can also get 0.5% discounts for attending seminars about risk-management and doing some CME booklets that they publish. I've cut 6.5% off my payments.
                        I am not a Dr so I dont have the same insurance but I will contact some local carriers in NY

                        Anyone have any carriers in NY I can contact

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                        • #13
                          I would like to point out that I am likely the only person on this board who has actual extensive experience with malpractice claims or malpractice insurers, given that I worked for one for eighteen years, and I am now managing a malpractice RRG\captive insurer for a multi-specialty group in the Pacific Northwest.

                          I have written extensively elsewhere (do a Google) and on the emrupdate.com site on the issue of discounts given by insurers for use of an EMR. In a nutshell, there is no data to support this, in ambulatory care, and any insurer who does give a discount is doing so based on one or two things: it is for marketing reasons, to get or keep the business; or they are betting that it will improve outcomes and reduce malpractice in the absence of any confirming data. Either approach is fine.

                          But no vendor or code writer should claim that their EMR will dramatically improve outcomes, reduce malpractice or earn a malpractice insurance discount unless they have actual data to back up their claims. Since I have been working in the area of malpractice claims defense and risk management for twenty years now, I would probably know about any such reliable data. As far as I am aware, there is none, in the ambulatory healthcare field.

                          Regards,

                          Michael Lloyd
                          Medex Consulting
                          Mill Creek, Washington
                          Healthcare risk management and applied clinical informatics
                          MGLloyd@msn.com

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                          • #14
                            Just talked to one of the lobyists in our state capital. Malpractice reform is causing a lot of agitation - but he told me we are dead in the water as the malpractice insurers came in to the committee meeting stating that they could not guarantee a rate reduction if caps were applied. He thought we might have a shot at preventing venue shopping.

                            Doesn't look like anything is going to change.

                            I gotta find a different line of work, stress is killing me.

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                            • #15
                              thanks for you comment Michael and Yes I agree.. in general
                              I was looking at hirschr comment's the the discount maybe for automatic tracking system etc which are trival from an EMR applicaton point of view and the lists maybe good idea's to deploy in the software anyhow..
                              So thats where my main interest is..

                              snip they are betting how true that is except the carriers dont like to pay up when they lose LOL

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