The HIMSS EHR Association, an affiliate of the Healthcare Information and Management Systems Society (HIMSS) that represents 44 EHR vendors, announced Monday that it is promoting the use of EHRevent, a year-old reporting system developed by the iHealth Alliance. The iHealth Alliance is a patient-safety organization convened by major U.S. medical societies, medical malpractice insurers, other patient-safety advocates, and liaisons from the U.S. Food and Drug Administration (FDA).
This news comes as influential consulting firm the AC Group has been circulating a white paper questioning whether EHRs may unwittingly raise physician risk for malpractice lawsuits, and whether poorly implemented EHRs would prompt liability insurers to raise their premiums. Meanwhile, the Institute of Medicine is preparing to release a major report this week on health IT and patient safety.
[For background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch.]
As InformationWeek Healthcare reported, one vendor, Athenahealth, is preparing a plan to cover the malpractice insurance premiums of certain customers and help those clients defend against malpractice suits.
So far, reporting on adverse EHR events has been limited because physicians fear being held liable for mistakes they admit to, which is why reports to EHRevents will be taken anonymously. "Everyone agrees that there needs to be more transparency in the process," Dr. Edward Fotsch, CEO of medical information database PDR Network, told InformationWeek Healthcare. PDR Network is hosting EHRevents on behalf of the iHealth Alliance, much as it hosts the RxEvent site for reporting adverse drug events.
"When you have massive amounts of taxpayer dollars at stake [in the federally supported Meaningful Use EHR incentive program], you should expect a certain level of transparency," said Fotsch, who was rather dismissive of the AC Group's report because it asked--but didn't answer--the key question about whether EHRs do raise physician exposure to malpractice suits.
The medical malpractice insurers themselves are unable to answer that question just yet, though.
"The risks [from EHRs] are just starting to be identified," said Dr. David Troxel, medical director of the Doctors Co., the nation's largest medical malpractice insurance carrier. The Doctors Co. has been working with the iHealth Alliance since EHRevent went live 10 months ago to "collate" adverse EHR events.
Troxel indicated the company is encouraging all 75,000 of its insured physicians to adopt EHRs. "However, with any new technology, there's always a learning curve," he said. "We are concerned, as are many, about the potential liability associated with electronic health records." Troxel said it was "a possibility" that the Doctors Co. could raise premiums for physicians using certain systems that are prone to errors, though he noted that there was not enough data available yet to make such a determination. EHRevent will help toward that goal, he said.
"Why not just put a very convenient reporting mechanism online?" added Troxel, who is an iHealth Alliance board member.
One area the IOM is looking at is whether there is a need for the U.S. Department of Health and Human Services to set up a reporting system. Troxel said that the iHealth Alliance has made the IOM aware of the patient-safety organization and its EHRevents system. "There's a potential that docs would be reluctant to use a government-run reporting system," according to Troxel.
The AC Group's review of 65 ambulatory EHRs that were certified to meet federal 2011 Meaningful Use standards found that more than 90% didn't offer "adequate medico-legal training" and that 95% raised specific legal issues.
"Either could increase the potential risk of a liability claim and would hamper its defense," the white paper said. "As is often the case, technology is advancing more rapidly than our ability to identify and address the medico-legal issues. The result of this uneven progression is that physicians and other stakeholders may be unknowingly exposed to medical liability risk."
Troxel said the Doctors Co. was taking the attitude that it "too early to tell" how EHRs would affect malpractice insurance rates and frequency of lawsuits. The reporting system is intended to help answer that question.