Harvard research links EHR use with malpractice claims reductions

Electronic health records hold promise along many avenues ranging from clinical documentation to coordination of care. And now, according to Harvard Medical School researchers, another advantage can be added to the list of potential benefits: a reduction in malpractice claims among EHR users.

Correlation does not imply causation, of course. But the report's authors say their findings, published June 25 in the Archives of Internal Medicine, suggest "implementation of EHRs may reduce malpractice claims and, at the least, appears not to increase claims as providers adapt to using EHRs."

The study, titled "The Relationship Between Electronic Health Records and Malpractice Claims," was written by Mariah A. Quinn, MD; Allyson M. Kats; Ken Kleinman; David W. Bates, MD; Steven R. Simon, MD.

"Given the potential of EHRs to reduce adverse events and health care costs, the question of whether EHRs reduce the risk of malpractice lawsuits is a logical one," they write.

"Risk factors for medical error and resultant malpractice claims -- including poor communication between providers, difficulty in accessing patient information in a timely manner, unsafe prescribing practices, and lower adherence to clinical guidelines -- may be ameliorable by health information technology," the report notes. "The high quality and availability of proper documentation in EHRs may increase the likelihood of successful defense against malpractice claims."

For this study, the researchers assessed groups of Massachusetts physicians who had previously been surveyed in 2005 and 2007 – tracking their malpractice claims over time.

"Because physicians in the sample were insured for different durations and used EHRs for variable amounts of time, the number of insured years was calculated for each physician before and after EHR adoption," they write. "We used Poisson regression to determine whether EHR use was associated with malpractice claims, modeling the rate of malpractice claims per year in periods with and without EHRs and adjusting for clustering by physician. We used the generalized linear mixed models version of Poisson regression to account for correlation between periods."

Of the 189 doctors surveyed in both 2005 and 2007, they note, 27 were named in at least one malpractice claim. Overall, 33 of the 275 physicians from multiple surgical and medical specialties who responded in 2005 and/or 2007 incurred a total of 51 unique claims. Forty-nine of those claims were related to events occurring before EHR adoption. Two were related to events occurring after EHR adoption.

"We found that the rate of malpractice claims when EHRs were used was about one-sixth the rate when EHRs were not used," the researchers write. "This study adds to the literature suggesting that EHRs have the potential to improve patient safety and supports the conclusions of our prior work, which showed a lower risk of paid claims among physicians using EHRs. By examining all closed claims, rather than only those for which a payment was made, our findings suggest that a reduction in errors is likely responsible for at least a component of this association, since the absolute rate of claims was lower post-EHR adoption."

The report, however, concedes that other factors may be at work. "For example, physicians who were early adopters of EHRs may exhibit practice patterns that make them less likely to have malpractice claims, independent of EHR adoption; these early adopters contribute a disproportionate amount of time in our analyses, favoring an effect of EHRs on reducing malpractice claims."

Still, the researchers argued, despite the small sample size, the reduction in malpractice claims shown in the EHR study "lends support to the push for widespread implementation of health information technology."

Access the report here.

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