Organizations vary in ability to use CDS to cut malpractice risk

Healthcare providers vary widely in their ability to use clinical decision support tools to assess malpractice risks, according to research published online Wednesday in the Journal of the American Medical Informatics Association.

The researchers previously analyzed malpractice claims from Partners HealthCare in Boston, finding that 123 of 477 claims in that study might have been prevented by CDS. That quarter of claims represented nearly 60 percent of the dollars paid out during the study period, in excess of $40 million.

For this study, they developed an online self-assessment tool based on various scenarios that explored various types of CDS in use. They then asked seven healthcare organizations to complete the self-assessment.

As an example of the questions in the self-assessment, a test-taker in a nurse role might be asked to document an aspirin allergy for a test patient, then attempt to order ketorolac and document whether CDS not only issued an alert, but provided more information.

The study found a range of CDS types in use. Most sites had drug-allergy checking, automated interpretation of electrocardiograms (EKGs), and checks for timely administration of drugs, for instance, yet none of them had pre-procedure planning for pulmonary artery catheterization or tracking of patient consents.

Overall, it found the proportion of potentially preventable indemnity loss for which CDS was available ranged from 16.5 percent to 73.2 percent.

Among the lessons learned:

  • The most common CDS types did not necessarily correspond to the areas of greatest malpractice risk exposure
  • At most sites, no single person was found sufficiently knowledgeable to complete the entire assessment
  • Some sites were surprised when a particular vignette did not trigger CDS, suggesting that even those responsible for CDS at a particular site might not fully know how it works

Reed Gelzer, M.D., co-facilitator of HL7 EHR Records Management and Evidentiary Support Profile Standard Workgroup, recently told FierceEMR there's a "critical mass" of problems related to the use of EHRs in malpractice suits.

He had previously warned that the data in EHRs is too inaccurate to be used in court.

Buyers of clinical decision support systems need more and better information to make informed purchase decisions, according to an article published earlier this year in JAMIA.

To learn more:
- find the research