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Paper record system has its own benefits
The Harvard study suggesting lower malpractice risk from using electronic medical records (EMRs) must be viewed with some skepticism, says Peter Hoffman, JD, an attorney with Eckert Seamans in Philadelphia.
"The conclusions were not statistically significant. It's not a study I would take to the bank, so to speak," he says.
Hoffman agrees that there are many potential benefits with EMRs, but he warns against the tendency to focus only on those and not also consider the downsides. For instance, Hoffman points out that a written note can provide the clinician more flexibility and the ability to write lengthier comments. The old ways of keeping patient records weren't all bad, he says.
"The flowsheets, for instance, allowed better productivity because health care workers could spend more time on their actual work. Where that method falls down is that it doesn't give you the extent of detail you might like to see," he says. "Part of the same issue applies to electronic records. So, instead of getting more specific, you get more general, with drop-downs on the screen. That can be a good thing or a bad thing, depending on how carefully the health care worker uses them."
Hoffman says he has seen EMRs in which he could not figure out what happened in the case, because there was not enough detail. He worries that providers may sacrifice necessary information for the sake of a digital record.
"Remember the labor and delivery charts we used to use, the fold-out Hollister-type forms? They were impossible to read, but they were packed with information," he says. "Now, they are not so packed. Nurses and doctors used to write on the fetal monitor strip, and it was useful information to have. Now, they can't do that because there's no strip to write on. They can put the same info in the computer, but do they?"
Similar issues worry Stuart Grossman, JD, an attorney with Grossman Roth in Boca Raton, FL. The successful adoption of EMRs will require that risk managers emphasize some of the same record-keeping goals that applied in paper records. The record, whether paper or digital, must tell a story and clearly document the key exchanges with the patient and the decision-making process, he says.
"I am concerned that there could be a tendency for people to become overly dependent on the computerized system, to just respond to the prompts without keeping in mind that they have to ensure there is a clear narrative of the patient care process," Grossman says. "Of course, that means you have to provide them with a system that at least allows that kind of thorough documentation, if not encouraging it. The first step in successfully using EMRs will be to provide your professionals with a system that allows them to do what you need them to do with that record."
For more information on EMRs, contact:
Stuart Grossman, JD, Grossman Roth, Boca Raton, FL. Telephone: (561) 367-8666.
Peter Hoffman, JD, Eckert Seamans in Philadelphia. Telephone: (215) 851-8420. E-mail: firstname.lastname@example.org.