Electronic Plagiarism

suc

Yup, that’s the new legal buzzword for medical lawsuits.  It’s called “electronic plagiarism”.  Remember how the EHR or EMR was going to save us so much time?  Well, we all know how that turned out.  Unfortunately, with all the extra clicks it has become too easy or all too common for doctors to take the easy road “cut and paste”.  This is a nice article explaining why we need to be more reserved in doing this.  Here are some excerpts:

  • In medical negligence claims, the accuracy of the patient’s medical record and the credibility of the health care providers are often both at issue, and many times the two go hand in hand.
  • Lawyers representing injured patients love to point out errors in the medical record, whether or not the error caused any patient harm, because – the argument goes – if the medical provider was careless in record-keeping, then chances are he/she was also careless in the treatment at issue. So too, if the jury is provided with facts that differ from the medical record, suspicion arises. Thus, an innocent but preoccupied provider is accused of lying or of trying to cover up a treatment error. 
  • Our experience in reviewing medical records for litigation suggests that a surprising number of practitioners routinely copy and paste information from a prior entry in the EHR. 
  • Copying can result in entering outdated or inaccurate information into the patient’s chart. Even simple errors of this kind can be very damaging.
  • If inaccurate information is relied on for treatment decisions, the results can be disastrous.It is often argued in litigation that if something doesn’t appear in the medical record it didn’t happen. A corollary to this dubious “rule” is that once bad information is documented in a medical record, it will be redocumented over and over and over again. Predictably, the more times the erroneous data are repeated in the EHR, the more “reliable” it becomes. This problem has been around a long time, but EHR plagiarism has made it worse.

The bottom line is that beware of the EHR succubus.  It seems easy but will get you in trouble in the end.  That doesn’t answer the question of how to keep up with your work without “copy and pasting”.  And, by the way, “quick texting” can get you in the same trouble.  How many times have you clicked in that shortcut key for a complete physical and forgot you used a male template on a woman?  It is embarrassing to see that her testicles showed no masses, right?  I have no answer to make this job quicker other than doing it in a place where you have the proper time to actually put all the information in the right spots and tie up all loose ends.  That is not Wonderland.  The only job that does that is Direct Primary Care.  🙂

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Electronic Plagiarism

  1. Kathy Wire
    May 17, 2014 at 9:31 am

    I know this is much easier to do with EMRs than paper, but I was doing risk management when almost nothing was digital, except certain exams. I used to struggle with the same issue in a teaching hospital, where the student would write a note, the resident would essentially copy it, and then it became history–repeated over and over with each change of service. I would have to dig through days or weeks of handwritten notes to find the original source of some stupid suspected (and completely wrong) diagnosis.

    I have to emphasize the point made in the article: a defensible record doesn’t have to be fancy or terribly extensive. It has to be credible. Three well-chosen and honest words about a relevant finding can have tremendous value. With continued evolution of EMR’s, with luck they will be more supportive of that.

  2. Madelyn
    May 15, 2014 at 3:17 pm

    When our first EHR was started there was an program error that caused all patients to be listed as smoking. After I took the time to report the patients this happened to I was told that there was not way to change the initial record. I just had to document it later. All of these patients showed up as previous smokers.

  3. Randy
    May 14, 2014 at 3:07 pm

    I agree with Sir Lance – way too much info for each note. The VA likes to tout its EMR – I’ve had nursing home transfers from the VA where you have to wade through ten to fifteen pages just to find the few lines that say why he was there. Despite not being able to find the reason for admission you are able to find his last tetanus shot.

    I use templates in my EMR too though. Unless you have scribes I don’t see a way for the EMR to be usable without them. You just have to know what’s in your template and if there’s any variation make sure you change it. Do I make mistakes in the charting sometimes, hell yes.

  4. Kris
    May 14, 2014 at 6:43 am

    I saw a patient at a health center who seemed to be getting a monthly rectal exam, all of them normal, every time he came in for his PT/INR. His regular doc was in the habit of clicking the “copy previous record” button for repeat exams and that caused the single rectal exam to appear a dozen times (along with the billing). Another common problem that I see, especially in ER records, is a phrase like : “A complete review of systems was otherwise negative,” or “a 12 point ROS was negative.” There’s an EMR button for this. Docs who use this feature seem to use it for all patients but I can’t believe that the extensive ROS is always done. For example, I’ve seen it used for minor injuries, like a stubbed toe. Who’s going to ask about cardiopulmonary, neuro, GI, derm, psych; etc. for a toe injury?

    • Pat
      May 14, 2014 at 10:10 pm

      This topic (again) demonstrates the necessity of primary care changing quickly to direct care. The entire premise is wrong and should be rejected: why should a 12-point ROS be done for a minor complaint or routine follow up for well-known longstanding conditions? The point of medical training is to learn and recognize “positive” symptoms and signs. WHY should we have to write down the negatives? It doesn’t improve care at all, and does complicate and add expense to everything.
      Of course we don’t do all ROS for minor complaints, but most of us document doing it because we need to get paid. A physician that fulfills all the demands of a third party insurer is guilty of dishonesty, or self-abuse.

  5. Sir-Lance-a-Lot
    May 14, 2014 at 6:14 am

    Never mind MY plagiarism (I admit it: sometimes I’ll copy my partner’s note when he’s writing up a chest pain for my patient with a head cold…), the thing that drives me crazy is the EMR’s plagiarism.

    Ever single goddamned note has the entire history, entire med list, entire social history, and every other detail of the whole chart. It’s impossible to find the six lines i’ve written (or the Orhopod has written, or the ER doc has written…) in the five hundred lines of text copied from previous notes by the EMR.

Comments are closed.