PHRs can boost efficiency, but also hold malpractice risk

August 7, 2009

Since personal health records could be the wave of the future, it is important to understand their risks and benefits.

Key Points

Since PHRs could be the wave of the future, it is important to understand their risks and benefits. While a PHR can save tremendous time, it is only as good as its content. The biggest risk associated with PHRs revolves around the possibility that a decision will be made with incomplete or insufficient data.

An ideal PHR would automatically update a patient's record at every office visit and hospital admission, as well as with every laboratory report and prescription filled. This would eliminate the need for repetitive history taking and testing, as well as the risk of obtaining incomplete or incorrect medical information.

Therefore, it is important to verify that the patient's history, as indicated in the PHR, remains accurate, and that the patient has not omitted any significant information when conveying his complaint. This will often involve a phone conversation with the patient.

Since a PHR cannot substitute for a physical exam, an office visit may still be necessary; what may appear routine on a history may look altogether different upon observation. The most important part of living in a PHR world may be deciding when to require the patient to come into the office, especially when that patient wants to avoid the inconvenience. A wrong decision will be immediately second-guessed if injury or harm results.

For now, there are no protocols in place for deciding when to treat electronically. It will be important to document the fact that you have confirmed the accuracy of the electronic information and advised the patient (when appropriate) that your diagnosis and treatment plan, absent a physical examination, imposes a risk that important information will not be available, altering the diagnosis or treatment. The record should also document that if symptoms do not resolve, or if additional symptoms develop, an office visit is required.

While this may sound daunting, these types of decisions are routinely made in an office setting. Complaints of a seemingly routine nature are often treated symptomatically before resorting to expensive diagnostic tests. Similar routine complaints may well lend themselves to symptomatic treatment before requiring the patient to be seen for an examination.

For now, the best advice is to make sure that the EHR you purchase will interact with the major PHRs and that you use the technology to reduce unnecessary redundancy. At the same time, you cannot allow the PHR to alter your practice to the point of taking unnecessary risks. It is one thing to increase efficiency by reducing redundancy. It is quite another to increase it by cutting necessary corners.

The author is a health law attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, New Jersey; Lake Success, New York; and Philadelphia. He can be reached at kern@drlaw.com. Malpractice Consult deals with questions on common professional liability issues. Unfortunately, we cannot offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please send it to memalp@advanstar.com
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