Malpractice risk and the EMR

So far, surprisingly little has been written about malpractice in the world of paperless medical records. Health Care Renewal has this post about a preemie who suffered complications following PICC insertion:

Within 48 hours, the PICC insertion site began to show evidence of compromise. The attending physician gave a verbal order to monitor the arm, but the order was never reduced to writing and no monitoring of the site was thereafter documented in the chart. Indeed, a comparison of the IV site care notes with the nursing notes revealed the use of an automated entry feature, confirmed by the defendants in discovery, which permitted the nursing staff to simply re-enter prior descriptions of a patient’s condition...

As a result, the nursing notes continued to describe the condition of the affected arm as normal when in fact it was continuing to visibly deteriorate. Thereafter, despite swelling and seepage at the PICC insertion site and discoloration of the hand, the PICC was not removed for an additional 48 hours. The decedent was flown to another facility where the right arm was amputated after becoming necrotic and gangrenous. The infant died after 36 days of life. Plaintiffs sued the nurses, hospital and neonatal specialists charged with the decedent’s care.

It's not clear whether this misled the doctors and directly contributed to the outcome, but it sure would have looked bad to a jury.


The post links to this article which discusses some of the liabilities of the EMR such as auto-generated entries and copy-and-paste functions.