What Can Go Wrong with EHRs? Legal-Ethical Dangers with Electronic Health Records Part I

EHRsWhile the implementation of electronic health records represents a great opportunity for improving health care delivery in the US, adoption and use of EHRs poses many serious legal and ethical dilemmas for health care practitioners. Since our legal system relies on case law and precedents we can expect significant lag time between the adoption of new technologies like EHRs and clear legal guidance regarding their use. In the absence of clear legal guidance, it’s important that we begin a constructive dialog about the most reasonable and appropriate means to navigate the brave new world of EHRs. In our previous blog posts, Finally! Easy Q&As about Electronic Health Records (EHR) for Mental Health, and Why Consider Electronic Health Records Now? we discussed many of the common questions that arise with EHRs. Some of the issues we’ll cover today involve responsibility, information overload, accountability, algorithms and alerts, documentation. Issues we’ll cover in our net two blog posts include software and systems, privacy and protection of PHI, data breaches, parental access to adolescent’s records, integrity and reliability of patient data, costs and proper data retention and storage. Responsibility With EHRs, all medical records for a single individual from multiple sources are easily accessible to every health care professional with access to that EHR. Some of the most important questions to consider are:

  • What is each provider’s responsibility for reviewing all the information from all organizations contributing to that EHR?
  • What happens when you mistakenly enter too little or too much information into a system?
  • What happens when another practitioner accidentally allows your patient records to be accessed by the patient without your awareness?

Information Overload Most health care practitioners are already experiencing information overload within their current record systems.  While all of this data is legally discoverable, the sheer volume of data to review makes it all too easy for providers to miss or overlook key findings despite the fact that those findings are documented and available. These questions arise for practitioners considering EHRs:

  • What happens if integrated EHRs, which can store virtually unlimited amounts of data covering multiple aspects of care, can be used to prove provider negligence when data was available and conveniently accessible but was not used in making diagnostic or treatment decisions.

Accountability EHRs increase legal accountability.  The audit log functions standard to all EHRs automatically identify which health care providers have reviewed or failed to review, key information in the EHR.

  • How much liability do clinicians have if they reviewed, but never addressed abnormal findings documented in the EHR?
  • What liability will there be for clinicians who should have reviewed key findings, but failed to do so?

Algorithms and Alerts Many EHRs include an expert system of algorithms to help users optimize treatment decisions and address safety concerns. These automatic information processing systems can lead to a high number of intrusive and frustrating alerts which can ultimately lead to “alert” fatigue on the part of the EHR user.

  • What liabilities do providers face if they choose to over-ride or do not follow or act on information from advanced clinical decision support system alerts?

Documentation Issues Documentation created using templates, automatic importation of test results, cut and paste functions, spell checkers and automatic word, phrase or paragraph completion macros pose serious liability concerns. These questions arise for practitioners considering EHRs:

  • Who is liable when clinical findings not directly relevant to a provider’s competence and specialization are imported into the record but are not integrated into treatment decisions?
  • What happens when incorrect or outdated information is cut and pasted into a new progress note? Notes and reports that bear a health care professional’s electronic signature imply responsibility for the entire contents of that document regardless of the original source or whether the information is within the purview of that provider.

In our next segments about EHRs, we will briefly discuss other concerns, which include software and systems, privacy and protection of PHI, data breaches, parental access to adolescent’s records, integrity and reliability of patient data. We will conclude this series with a summary of how the EHR can nonetheless make your life easier in the long run. Mark You Calendar Join us for a FREE 1-hour webinar with noted EHR specialist, Lisette Wright, an EHR consultant from OPEN MINDS. She will outline the key issues and answer your questions on February 25th. If you haven’t yet seen the description of our webinar, or registered to be informed of our free monthly webinars, sign up for Why Consider the EHR Now? An Electronic Health Record (EHR) Primer, here. FREE recording will also be made available afterwards. For 1 CEU or CME, transcripts and slides, visit this page.


Disclaimer: The views and opinions expressed in the article and on this blog post are those of the authors. These do not necessarily reflect the views, opinions, and position of the Telebehavioral Health Institute (TBHI). Any content written by the authors are their opinion and are not intended to malign any organization, company or individuals.

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