How to Use Electronic Health Records to Achieve the Quadruple Aim

Abstract

I applaud the Research Letter by Quinn et al. 1 It provides a welcome counterpoint to previous reports raising fears that electronic health records (EHRs) may result in increased errors and patient injury. My colleagues at Princeton Insurance Company and I undertook a comprehensive study to determine what care gaps most often associated with litigation could be minimized by the appropriate use of EHRs and their safetyenhancing functionalities. We analyzed 7000 closed and open claims over a 6-year period at Princeton Insurance Company. The Harvard Risk Management Foundation provided coding books and trained abstractors to identify hundreds of potential care gaps associated with these lawsuits. These care gaps were grouped into 4 broad categories of errors that could be addressed by the appropriate use of EHRs: clinical judgment errors; communication gaps (between physicians and patients and between physicians and other health care providers); documentation discrepancies (as to the mechanics and sufficiency of documentation); and office systems deficiencies (concerning tracking of patients’ tests ordered, results, and follow-up). We interviewed in person top executives from 5 leading EHR companies and had them submit hundreds of screen shots to demonstrate how appropriate use of their products could address these most common care gaps associated with litigation. On site, we interviewed physicians and practice managers using these products to validate these companies’ claims. For further validation, we interviewed defense attorneys who represented physicians in cases, where appropriate use of EHRs was at issue. We compiled all this information into a guide concerning how to use EHRs to improve quality, while minimizing the risks of patient injury and litigation. We are confident that as health care providers implement EHRs throughout the remainder of this decade, using all of the safety enhancing functionalities of these products will result in their meeting the quadruple aim of improving care, enhancing population health, decreasing costs, and minimizing litigation.