The Electronic Health Record is the subject of a current article in The online magazine Politico.com on malpractice litigation. Click here for the link. In a nutshell the number of malpractice lawsuits resulting from medical errors linked to the EHR is skyrocketing. Readers of these pages will recognize this theme. Dr. Stark has predicted that this would happen. The Doctors Company, the largest physician-owned malpractice carrier, did an analysis of their lawsuits. That analysis can be found here, and is the basis of the report in Politico. An important cause cited was the failure of the EHR to alert the physician that he had approved an abnormal value for inclusion in the patient’s chart without doing anything about it. Other leading causes were design failure and what they called a routing failure — presumably failure to notify those people most able to intervene on the patient’s behalf. Dr. Stark comments, “For the last year of my practice I was forced to use an EHR. It was poorly designed — too complex for starters with no prompts for unresolved problems. When I suggested to the administrators of my health-care system that I could help them improve their design to overcome these shortcomings, their response was patronizing, to say the least. Life-threatening lab values could be signed off by the doctor; if he or she didn’t have a plan of action to solve the problem, the system didn’t care. The best products on the market won’t let you close a chart unless you articulate solutions to problems; not so here. I bore witness to disasters about to happen, and some that did happen before I became involved. The copy and paste approach to progress notes is another issue. It is a substitute for critical thinking. Mistakes get perpetuated rather than corrected.”