Harvard study suggests adoption of an electronic health record system may have a positive impact.
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The rate of malpractice claims after EHR adoption is about one-sixth the rate that occurs before the technology is adopted, suggests an observational study led by researchers at Harvard Medical School.
Published on the Archives of Internal Medicine website, the study involved a pre-post assessment of physicians who had implemented EHRs, randomly selecting doctors from a list of practices that had malpractice claims filed against them. The list was taken from a malpractice insurer in Massachusetts for physicians covered from 1995 to 2007 and included both surgical and non-surgical specialties.
The study was based on a combination of surveys conducted in 2005 and 2007 that assessed adoption of EHRs. The first included 275 physicians in 2005. The second study, conducted in 2007, revisited physicians who had participated in the first study. In the second poll, 189 physicians responded.
"Overall, 33 of the 275 physicians from multiple surgical and medical specialties who responded in 2005 and/or 2007 incurred a total of 51 unique claims; 49 of these claims were related to events occurring before EHR adoption, and 2 were related to events occurring after EHR adoption," researchers wrote.
The importance of discovering an association between the use of EHRs and a reduction in malpractice claims cannot be underestimated, explained lead author Mariah Quinn, MD, MPH, MD, MPH.
Quinn said malpractice claims result in substantial costs both directly (due to costs incurred over the course of investigating, prosecuting, and defending claims) and indirectly, owing to the more difficult-to-quantify cost of defensive medicine. This arises because doctors, fearing malpractice suits, are widely thought to order more tests, such as CAT scans, ultrasounds, or more invasive tests that escalate costs. Estimates of the yearly cost of the medical liability system run as high as $55.6 billion.
"The study shows that EHRs are associated with reduced malpractice claims, and if the true relationship between EHR use and malpractice claim reduction is through a reduction in errors, that's going to lead to fewer malpractice lawsuits," Quinn told InformationWeek Healthcare. "The study should at least allay the fears of those who worry that EHR adoption will increase their malpractice risk."
Despite the study's positive results, Quinn pointed out that the observational study can't account for all other factors that may also have contributed to a reduction in malpractice claims.
According to the authors of the study, "Unmeasured factors may, in part, account for the apparent six-fold reduction in malpractice claims attributed to EHRs. For example, physicians who were early adopters of EHRs may exhibit practice patterns that make them less likely to have malpractice claims, independent of EHR adoption."
Nevertheless, the report went on to say: "While this study includes only a small number of post-EHR claims, it suggests that implementation of EHRs may reduce malpractice claims and, at the least, appears not to increase claims as providers adapt to using EHRs."
With that in mind, Quinn is holding out hope that as EHR vendors add more advanced features and functionality, the technology will make an even more profound contribution to malpractice claim containment in the future.
"Earlier EHRs wouldn't have been nearly as capable of providing well-built features such as decision support or information that helps identify conflicts in medication," Quinn said. "If what we are seeing is truly a reduction in errors because of the use of EHRs, then I would expect that more mature EHRs will provide better functionality that should help to mitigate malpractice claims."
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