Medical Malpractice Liability in the Age of Electronic Health Records

Purpose The Adolescent and Young Adult (AYA) community is an underserved population due to unique quality of life and late-effect issues, particularly future fertility. This study sought to establish rates of documentation of discussion of risk of infertility, fertility preservation (FP) options, and referrals to fertility specialists in AYA patients’ medical records at four cancer centers. Methods All centers reviewed randomized medical records within the four most common disease sites among AYAs (breast, leukemia/lymphoma, sarcoma, and testicular). Eligible patient records included: 1) diagnosed in 2011 with no prior gonadotoxic therapy; 2) ages 18–45; 3) no multiple primary cancers; and 4) not second opinions. Quality Oncology Practice Initiative (QOPI) methods were used to evaluate documentation of: a) discussion of risk of infertility; b) discussion of FP options; and c) referral to a fertility specialist. Results A total of 231 records were analyzed. Overall, 61 (26%) of records documented item a; 56 (24%) documented item b; and 31 (13%) documented item c. Female (p = 0.030; p = 0.004) and breast cancer (p = 0.021; p < 0.001) records were less likely to contain evidence of a and b. Conclusion The overall rate of documentation is low and results show disparities among specific groups. While greater numbers of discussions may be occurring, there is need to create interventions to improve documentation. Rates may improve with increased provider education and other intervention efforts.

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“…Finally, documentation of counseling in the medical record provides evidence that can reduce malpractice liability for the physician. 41 …”

Section: Discussionmentioning

confidence: 99%

If You Did Not Document It, It Did Not Happen: Rates of Documentation of Discussion of Infertility Risk in Adolescent and Young Adult Oncology Patients' Medical Records

Quinn

Block

Clayman

et al. 2015

JOP

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“…"* Second, EHRs may increase clinicians' legal responsibility and accountability. 19 Sophisticated computer-based auditing procedures, 20 as opposed to paper-based record sign-out logs, can identify individuals who review, or fail to review, key information in the EHR. 21 Take the scenario in which an abnormal finding is documented in the EHR and subsequently reviewed by multiple clinicians but never addressed.…”

Section: Legal Dilemmasmentioning

confidence: 99%

Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use

Sittig

Singh

2011

Pediatrics

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Electronic health records (EHRs) facilitate several innovations capable of reforming health care. Despite their promise, many currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that must be addressed in the near-term pertain to the extent of clinicians' responsibilities for reviewing the entire computer-accessible clinical synopsis from multiple clinicians and institutions, the liabilities posed by overriding clinical decision support warnings and alerts, and mechanisms for clinicians to publically report potential EHR safety issues. Ethical dilemmas that need additional discussion relate to opt-out provisions that exclude patients from electronic record storage, sale of deidentified patient data by EHR vendors, adolescent control of access to their data, and use of electronic data repositories to redesign the nation's health care delivery and payment mechanisms on the basis of statistical analyses. Finally, one overwhelming financial question is who should pay for EHR implementation because most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders begin discussing these issues in a national forum. These actions can help identify and prioritize solutions to the key legal, ethical, and financial dilemmas discussed, so that widespread, safe, effective, interoperable EHRs can help transform health care.

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“…Disclosures without individual patient consent have resulted in tortious or contractual claims of invasion of privacy, breach of confidentiality or implied statutory violations under state law,44 and the increasing collection and disclosure of electronic information raises physicians' malpractice liability exposure 45…”

Section: Introductionmentioning

confidence: 99%

A secure protocol for protecting the identity of providers when disclosing data for disease surveillance

Emam

Mercer

et al. 2011

Journal of the American Medical Informatics Association

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BackgroundProviders have been reluctant to disclose patient data for public-health purposes. Even if patient privacy is ensured, the desire to protect provider confidentiality has been an important driver of this reluctance.MethodsSix requirements for a surveillance protocol were defined that satisfy the confidentiality needs of providers and ensure utility to public health. The authors developed a secure multi-party computation protocol using the Paillier cryptosystem to allow the disclosure of stratified case counts and denominators to meet these requirements. The authors evaluated the protocol in a simulated environment on its computation performance and ability to detect disease outbreak clusters.ResultsTheoretical and empirical assessments demonstrate that all requirements are met by the protocol. A system implementing the protocol scales linearly in terms of computation time as the number of providers is increased. The absolute time to perform the computations was 12.5 s for data from 3000 practices. This is acceptable performance, given that the reporting would normally be done at 24 h intervals. The accuracy of detection disease outbreak cluster was unchanged compared with a non-secure distributed surveillance protocol, with an F-score higher than 0.92 for outbreaks involving 500 or more cases.ConclusionThe protocol and associated software provide a practical method for providers to disclose patient data for sentinel, syndromic or other indicator-based surveillance while protecting patient privacy and the identity of individual providers.

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Medical Malpractice Liability in the Age of Electronic Health Records

Cited by 84 publications

References 37 publications

If You Did Not Document It, It Did Not Happen: Rates of Documentation of Discussion of Infertility Risk in Adolescent and Young Adult Oncology Patients' Medical Records

If You Did Not Document It, It Did Not Happen: Rates of Documentation of Discussion of Infertility Risk in Adolescent and Young Adult Oncology Patients' Medical Records

Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use

A secure protocol for protecting the identity of providers when disclosing data for disease surveillance

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