The clock is ticking.

Congress has mandated all medical practices adopt a certified electronic health record (EHR)/electronic medical record (EMR) system and demonstrate “meaningful use” of the system by 2015 or their Medicare/Medicare reimbursements will be gradually and progressively reduced.

More and more aesthetic surgery practices are also transitioning over to EMRs from the traditional paper chart system.

A recently released report by Athena Health states that physicians reported an increase by hospitals using EMR systems from 2011 to 2012. This report also showed that the number of physician practices using EMR systems has increased significantly in the last year.

As EMRs become more pervasive and expansive, we need to acknowledge the risks associated with these digital systems, and work toward minimizing them.


EMRs are more than an electronic version of the paper chart. They pose unique risks and opportunities. In 2010, the New England Journal of Medicine reported that shortly after implementation, EMRs can:

  • Increase computer-related errors;
  • Increase mortality; and
  • Increase the rate of failures to report abnormal test results.

The risks don’t end here.

A study reported just months ago in the Annals of Family Medicine found that type 2 diabetes patients in practices using traditional paper chart records achieved better intermediate outcomes than patients in practices with EMR systems.

Michael J. Sacopulos


1) Leave your keyboard and interact with your patient.

I have heard countless complaints that physicians spend more time entering data than talking to their patients. Obviously, charting is, and should be, a part of each visit, but the primary focus should always be the patient—not the keyboard and monitor.

2) Avoid alert fatigue.

EMRs have built-in reminders to help reduce the risk of medical errors. The problem is, once you get comfortable with your EMR software, you could develop “alert fatigue.” Avoid this by setting alerts for significant events only. For example, the fact that a patient has a balance owed to the practice should not trigger a physician alert. The key is to use the alert feature wisely. Set too many alerts and they will be ignored, and set too few alerts and something may be missed.

3) Cut out cutting and pasting.

I was recently told by a risk management executive for one of the leading medical malpractice liability insurance companies that she routinely sees examples of physicians cutting and pasting text into medical records. This along with auto fill features found in some EMR systems allows language to be inserted into a patient’s chart without actually being typed by the physician or staff. There will be an electronic trail showing how this language got into the patients chart. Anything that populates a chart without a physician’s attention is a bad idea, and can set the stage for potential medical errors and subsequent lawsuits.

4) Do not allow your staff to share passwords.

EMR systems capture who views records as well as who generates content for medical records via user passwords. Although this information may not appear on the surface of the document, it is housed in a way that can be found in an audit trail. All entries are time- and date-stamped. This information may not be immediately apparent from a viewing of the record, but it has been captured internally by the system. Should there be a problem with the records or accusations of unauthorized viewing of a patient’s electronic charts, you will want to have the ability to go back and see who was involved. If staff members share passwords or use a common password, the internal tracking system of the EMR will be worthless.

Over time, we will all learn how to navigate the risks and opportunities that come with the widespread use of EMR systems. Until that time comes, these four simple steps will maximize the benefits of these systems while minimizing their risks.

Michael J. Sacopulos is the CEO of Medical Risk Institute (MRI) and serves as General Counsel for Medical Justice Services. He is the legal analyst for Plastic Surgery Practice, and can be reached via [email protected].