As part of his economic recovery program, President Barack Obama wants to invest in converting paper health records to electronic health records (EHRs). Analyses of the potential benefits of such a conversion suggest that President Obama’s proposal has merit. “Errors will happen anytime you take a complex system and put human beings inside of it,” says Dr. Brent James, vice president of medical research and executive director of Salt Lake City’s Intermountain Institute for Health Care Delivery Research. “The notion that you can train doctors to completely avoid mistakes is just false."

This is especially true when dealing with emergency patient care. Emergency room patients do not have the opportunity to screen and evaluate emergency room doctors and staff and make an informed choice about whose hands they place their lives in, as they would when choosing a physician or surgeon under normal circumstances. Yet, emergency room treatment may be the most important and extreme medical attention a person ever receives. According to The Institute of Medicine, a non-profit organization chartered by the U.S. National Academy of Sciences, at least 1.5 million Americans fall prey to hospital error every year. The mistakes aren’t exactly minor, either. Between 40,000 and 100,000 people die every year because of shoddy work, including surgical mishaps and drug mixups. One big problem: hospital patients may get the wrong drug one time out of five, according to a study by Auburn University. The death toll from mistakes is at least as bad as that from car accidents or breast cancer, and may be as bad as that from strokes.

Hospitals can minimize the risk of errors by maintaining clear and consistent policies and procedures for record keeping, patient tracking, administering medications, and sanitation. Policies and procedures only work when followed up with training and enforcement. In a high stress environment, all of these elements are necessary to keep things running smoothly. Use of EHRs may help reduce paid malpractice settlements for physicians, according to a new study. The study, which appeared in the November 24, 2008, issue of Archives of Internal Medicine, showed a trend toward lower paid malpractice claims for physicians who are active users of EHR technology. This study was based at the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care.

Health care policymakers have touted the benefits of EHRs, which include preserving and documenting patient health care data, reducing medication errors, improving efficiency of care, and allowing surveillance and monitoring of care for research and quality improvement. “There is broad consensus that electronic health records are an essential foundation for the delivery of high quality care. As electronic health record adoption proceeds as a national health policy objective, some have wondered whether EHRs can help to prevent medical malpractice claims,” says Assistant Professor Steven Simon, senior author on the paper.

The study examined survey responses from 1140 practicing physicians in Massachusetts during 2005 concerning their demographic characteristics and the length and extent of their EHRs use. The physicians’ malpractice history was accessed using publicly available data from the Commonwealth of Massachusetts’ Board of Registration in Medicine. The study team compared the presence or absence of malpractice claims among physicians with and without EHRs, including only claims that had been settled and paid. Overall, 6.1% of physicians with EHRs and 10.8% of physicians without them had paid malpractice settlements in the preceding ten years. After controlling for potential confounding variables, there remained a trend favoring EHR use, although the result was not statistically significant. In a secondary analysis among EHR adopters, the authors found that 5.7% of more active users of their systems had paid malpractice settlements, compared with 12.1% of less active users. Small numbers of physicians in both groups led the authors to interpret the results with caution.

The investigators speculate that EHRs may decrease paid malpractice claims for a number of reasons. EHRs offer easy access to patients’ history, which may result in fewer diagnostic errors, improved follow up of abnormal test results, and better adherence to clinical guidelines. In addition, the clear documentation of care allowed by EHRs can bolster legal defenses if a malpractice claim is filed. If this link between EHR use and lower malpractice payments is confirmed in further studies, malpractice insurers may offer lower premiums for practices that use EHRs, and there would be further incentive for physicians to invest in an EHR system for their offices. For example, the federal government may offer subsidies for EHR adoption. Although conversion to EHRs has significant potential benefits, its use also raises concern among some physicians and patients about the privacy of EHRs. To allay that concern, proponents of the use of EHRs will have to demonstrate that EHRs can be kept confidential.