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Electronic Health Record–Related Events in Medical Malpractice Claims

Graber, Mark L., MD, FACP*; Siegal, Dana, RN, CPHRM; Riah, Heather, MBA; Johnston, Doug, MTS*; Kenyon, Kathy, JD

doi: 10.1097/PTS.0000000000000240
Original Article: PDF Only

Background There is widespread agreement that the full potential of health information technology (health IT) has not yet been realized and of particular concern are the examples of unintended consequences of health IT that detract from the safety of health care or from the use of health IT itself. The goal of this project was to obtain additional information on these health IT–related problems, using a mixed methods (qualitative and quantitative) analysis of electronic health record–related harm in cases submitted to a large database of malpractice suits and claims.

Methods Cases submitted to the CRICO claims database and coded during 2012 and 2013 were analyzed. A total of 248 cases (<1%) involving health IT were identified and coded using a proprietary taxonomy that identifies user- and system-related sociotechnical factors. Ambulatory care accounted for most of the cases (146 cases). Cases were most typically filed as a result of an error involving medications (31%), diagnosis (28%), or a complication of treatment (31%). More than 80% of cases involved moderate or severe harm, although lethal cases were less likely in cases from ambulatory settings. Etiologic factors spanned all of the sociotechnical dimensions, and many recurring patterns of error were identified.

Conclusions Adverse events associated with health IT vulnerabilities can cause extensive harm and are encountered across the continuum of health care settings and sociotechnical factors. The recurring patterns provide valuable lessons that both practicing clinicians and health IT developers could use to reduce the risk of harm in the future. The likelihood of harm seems to relate more to a patient's particular situation than to any one class of error.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share thework provided it is properly cited. The work cannot be changed in any way or used commercially.

From *RTI International, Research Triangle Park, North Carolina; †CRICO, Cambridge, Massachusetts; and ‡Office of the National Coordinator for Health Technology, Washington, District of Columbia.

Correspondence: Mark L. Graber, MD, FACP, 5 Hitching Post, Plymouth, MA 02360 (e-mail:

The authors disclose no conflict of interest.

This report was sponsored by the Office of the National Coordinator for Health Technology under contract number HHSP23320095651WC_HHSP23337047T to RTI International.

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