Physicians Who Use EHRs Pay Fewer Malpractice Claims

Physicians who say they can't afford to purchase an electronic health record, or EHR, system may want to evaluate new research that suggests physician practices that use EHRs have fewer paid malpractice claims.

The study, "Electronic Health Records and Malpractice Claims in Office Practice," was published in the Nov. 24 Archives of Internal Medicine. Researchers looked at 10 years of data on paid malpractice settlements across the state of Massachusetts.

Study results show that of the 1,140 physicians who responded, 33.2 percent use EHRs in their practices. Of these respondents, 6.1 percent had a record of paid malpractice claims compared with 10.8 percent of physicians who did not use an EHR.

Lead study author Steven Simon, M.D., M.P.H., associate professor in the department of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care in Boston, said in an interview that the research filled a void.

"Studies to date have failed to show convincingly that electronic health record adoption alone simply improves quality of care," said Simon. We were trying to "find additional support for what most clinicians who have EHRs feel and believe … that having such a system does help them provide higher quality and safer health care for their patients."

Simon said his was the first published study to look at EHR adoption and use alongside paid malpractice claims.

The researchers said in the study that the results should be considered preliminary, but they did note several ways the research could directly affect physician practices. For instance, if the results are replicated in future studies,

"My hope would be that the health insurance community increasingly recognizes the value to them of their physicians and practices having these systems," said Simon. "There will be a lot of research in the next handful of years, and I'm actually very hopeful and confident that our results will be borne out in other studies."

Simon said he was surprised that the study results were consistent across high-risk and low-risk medical specialties. Although the study data are sparse, they show that, regardless of specialty, physicians in the study were half as likely to have paid a malpractice claim if they had an EHR.

"I would have thought that specialists in primary care might get more benefit from the EHR," than subspecialists, such as surgeons, said Simon. That's because when primary care physicians make medical errors, they're usually related to the cognitive process.

For instance, family physicians need to prescribe appropriately, remember to do the right test and make sure they follow up on abnormalities. All of those are "amenable to the EHR helping," because the EHR provides prompts and reflags, said Simon.

On the other hand, surgeons would seemingly have more procedural types of medical errors less affected by the presence of an EHR, he added.

Simon called it "a little bit of a stretch beyond our data" but said the study results suggest that "what's good for the family physicians and the internists seems to be good for the surgeons, and should be good, at least theoretically, for the psychiatrists and for other clinicians as well."

To test the role of an EHR's functionality, Simon and his fellow researchers split participants into two groups and labeled them "high users" and "low users."

Physicians in the first group used 50 percent or more of their EHRs' available functions most or all of the time. Low users used less than 50 percent of their systems' available functions most or all of the time.

Simon said his hypothesis -- that high users would get more benefit from the EHR -- was correct. Results showed that about 6 percent of high users had paid malpractice claims in the past 10 years compared with 12 percent of low users.

The results drive home the argument that purchasing and installing an EHR system is not enough, said Simon.

"In order to improve quality and safety, an EHR really needs to have robust features, like clinical decision support, electronic prescribing, order entry and the ability to communicate with other clinicians," said Simon. And physicians need to learn how to use all of the functions, he added.