Electronic health records (EHRs) are creating a malpractice paradox, a pair of legal analysts says.


“Although the use of EHRs is integrally related to improving patient safety, adopting EHRs may raise new risks of liability,” Joel B. Korin and Madelyn S. Quattrone write in the New Jersey Law Journal. Both lawyers have extensive experience defending physicians.

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For example, many systems generate reminders for tests or follow-up. Will those prompts become part of the record that must be made available to a plaintiff’s attorney? Will they define the standard of care? What happens when a physician makes a clinical decision to override a prompt?


Answers to these questions will develop over time, as future malpractice cases work their way through the courts. Meanwhile, if you decide to ignore a prompt, be sure to document your reasons, advises Quattrone, a senior risk management analyst at the ECRI Institute in Plymouth Meeting, Pa. 


“Accurate documentation of a physician’s thought processes may be the key to a successful defense against a claim of negligence in clinical decision-making,” she says, adding that some systems actually prompt doctors to explain their overrides.


Physicians must also spend the time and effort necessary to learn their EHR systems properly to avoid inadvertent mistakes in documentation or in the transmission of clinical information, Quattrone urges.


“Nearly all physicians who have gone through the transition from paper to electronic records—as painful as it may have been—have told me that they never want to return to the paper record,” Quattrone adds.


Moreover, whereas EHRs may incur new risks, good risk man-agement remains the same as al-ways, stresses Korin, a litigator with Ballard, Spahr, Andrews and Ingersoll in Voorhees, N.J.: “Practice standard-of-care medicine and document what you do.”