Birmingham University. UK: The widespread adoption of electronic patient records in health
care may have significant consequences for medical litigation in the UK,
according to a paper published today in the British Journal of General Practice.
The paper suggests that the ease of accessing records could lead
to people hunting for evidence of medical negligence – and has potential
to spark a culture of ‘electronic ambulance chasing’.
Professor Tom Marshall, from the University of Birmingham,
explained, “Daytime television already advertises for potential
litigants for those who suffered accident or injuries at work, it may
not be long before we see adverts aimed at patients recovering from
strokes, cardiovascular disease or cancers.”
Patients or lawyers requesting electronic patient records is
nothing new, and is commonly used as part of the litigation process.
However, Professor Marshall argues that it is now likely to affect the
likelihood that litigation will be initiated in the first place.
To demonstrate medical negligence, a claimant must show that the
doctor failed to meet the required standard of care. Electronic records
must be disclosed to claimants on request, and they include enough
information to show whether the doctor followed the guidelines by
investigating symptoms or offering treatment.
The paper argues that guidelines, like those written by NICE, are
increasingly seen as the required standard of care which doctors must
meet. If a patient suffered an adverse outcome because a doctor had
ignored or overlooked the guideline, then it could be considered as
negligence.
Professor Marshall said, “To put it bluntly, if a doctor departs
from the clinical guidelines, fails to record a rationale for doing so
and their patient suffers a foreseeable adverse outcome as a result,
this could be the basis for a medical negligence claim”
It is widely recognised that patients who suffer strokes often had
missed opportunities for prevention. They might display high blood
pressure that was measured but not treated, or an irregular pulse
(atrial fibrillation) which should mean they were prescribed blood
thinners (anticoagulants).
According to Public Health England (link), there were 68,536
hospital admissions for stroke during 2011-12. 28.8% of these had a
secondary diagnosis of atrial fibrillation. NICE guidelines recommend
that atrial fibrillation patients at high risk of stroke are prescribed
anticoagulants, which halves their risk of stroke.
Using electronic patient records, previous research found that
84.5% of atrial fibrillation patients meet these criteria, but only
50.7% were given anticoagulants.
In real terms, that means that about 12.3% of first strokes occur
in patients with atrial fibrillation, who are eligible for
anticoagulants but not receiving them.
From the perspective of a medical negligence lawyer, this means
that you’d only need to scan eight records of stroke cases to find one
possible negligence claim. Using the 2011-12 numbers, that would amount
to 8,436 cases per year.
Similarly, many patients with bowel cancer were known to have anaemia long before they were referred for investigation.
Lawyers could speculatively seek permission from anyone who
suffered a stroke or heart or anyone whose cancer was diagnosed late to
look for evidence of negligence by comparing the record against
guidelines.
“Doctors who step away from the guidelines need to record their
reasons for doing so,” Professor Marshall added, “Electronic records
mean that their omissions can easily be found out and they’ll be under
more scrutiny than ever before.”