It may surprise you that of all the medical errors that can occur, only three types account for the majority of EHR-related patient harm events cited in malpractice claims.

According to a study published in the Journal of Patient Safety, medication errors, diagnostic errors, and treatment complications account for 90% of claims citing EHRs. Medication errors and treatment complications each represented 31%, with diagnostic errors rounding out the remaining amount at 28%.

To arrive at these findings, researchers looked at claims submitted to the CRICO Comparative Benchmark System (CBS), a national database of medical malpractice claims from both commercial and captive insurance companies. The study reflects “both hospital and clinician risk in academic and community environments and across all care settings.” Researchers analyzed 248 incidents occurring between 2012 and 2014, and prominent findings from their research included:

• Most cases (146) came from the ambulatory care setting, compared to 77 in-patient and 25 emergency department (ED) cases. 
• That said, in-patient errors were most common among nurses.
• There were no cases from extended care facilities.
• The services with the most claims were medicine, followed by surgery, nursing, obstetrics/gynecology, and radiology.
• User-related EHR issues were more common (63%) than technology/system-related issues (58%).
• User and technology problems were equally dangerous, with 29% and 26% respectively resulting in death.
• More than 80% of all cases were considered high or medium severity.
• Ambulatory care cases were less likely to be lethal (18%) than in-patient or ED cases (39%).

Findings regarding the most common types of errors include:

• Of the 76 medication-related errors, the most common problems were related to orders, improper management, and administration.
• Diagnostic errors were the leading allegation in ED and ambulatory settings. 
• Of the 69 diagnostic errors, 30 resulted in death.
• Of the 42 diagnostic cases with a user-related issue: 32 were ambulatory cases, 16 were related to EHR-related codes difficult to use during an EHR conversion, 10 cases failed to appreciate a deteriorating clinical situation due to pre-populating or copy/paste functions, 7 cases were related to misrouted information.
• 28 of the diagnosis-related cases involved delayed diagnosis of cancer.
• 25 cases were related to acute problems such as myocardial infarction (5 cases), cardiomyopathies or endocarditis (5 cases), pulmonary embolism (4 cases), pneumonia (3 cases), or other infections (8 cases). 
• The remaining cases involved delayed or missed diagnosis of fractures, HIV, and post-operative complications.

The authors used this data to conclude that EHR-related harm is more severe than previous patient-safety reporting programs indicated. They also remind readers that such errors can occur in any care setting. The researchers stated, “Healthcare professionals, their organizations, and health IT vendors can decrease the risk of harm related to using electronic medical records by appreciating and addressing the lessons that these cases provide.” 

The authors recommended that when converting from one EHR system to another or upgrading or adding new functionality, establish “a well-defined action plan and appropriate resources to ensure complete and accurate data is available as rapidly as possible.”

As with many forms of technology, system failures often occur with EHR systems. Common system failures include delays in returning critical laboratory values, lost or misdirected important pathology results, incorrectly pasted information, and urgent products being misrouted. The authors noted, “Providers need to appreciate these vulnerabilities so that they can take appropriate steps to validate data, to ensure timely follow up on tests that are ordered, or to inquire directly about services or products that appear delayed. If key data is missing in the EHR, providers need to find it.” 

Recommendations also included limiting the copy-paste function, using simple EHR interfaces, improving EHR training, promoting health IT standardization, and not overriding medical alerts.

The researchers stated, “...Just as quality in clinical care involves constant monitoring and questioning to ensure that diagnosis and treatment are correct, there should be a comparable level of vigilance and appreciative inquiry regarding using the EHR. Data and information that raises an eyebrow should be verified or rechecked.”