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Identifying a Clinical Informatics or Electronic Health Record Expert Witness for Medical Professional Liability Cases

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Abstract Background  The health care field is experiencing widespread electronic health record (EHR) adoption. New medical professional liability (i.e., malpractice) cases will likely involve the review of data extracted from… Click to show full abstract

Abstract Background  The health care field is experiencing widespread electronic health record (EHR) adoption. New medical professional liability (i.e., malpractice) cases will likely involve the review of data extracted from EHRs as well as EHR workflows, audit logs, and even the potential role of the EHR in causing harm. Objectives  Reviewing printed versions of a patient's EHRs can be difficult due to differences in printed versus on-screen presentations, redundancies, and the way printouts are often grouped by document or information type rather than chronologically. Simply recreating an accurate timeline often requires experts with training and experience in designing, developing, using, and reviewing EHRs and audit logs. Additional expertise is required if questions arise about data's meaning, completeness, accuracy, and timeliness or ways that the EHR's user interface or automated clinical decision support tools may have contributed to alleged events. Such experts often come from the sociotechnical field of clinical informatics that studies the design, development, implementation, use, and evaluation of information and communications technology, specifically, EHRs. Identifying well-qualified EHR experts to aid a legal team is challenging. Methods  Based on literature review and experience reviewing cases, we identified seven criteria to help in this assessment. Results  The criteria are education in clinical informatics; clinical informatics knowledge; experience with EHR design, development, implementation, and use; communication skills; academic publications on clinical informatics; clinical informatics certification; and membership in informatics-related professional organizations. Conclusion  While none of these criteria are essential, understanding the breadth and depth of an individual's qualifications in each of these areas can help identify a high-quality, clinical informatics expert witness.

Keywords: health; clinical informatics; electronic health; medical professional; health record; professional liability

Journal Title: Applied Clinical Informatics
Year Published: 2022

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