Sept. 17, 2019
Three Moore School professors found that hospitals which implement new health information technology (HIT) systems see a decrease in medical malpractice suits – but only if their medical providers are effective communicators.
The team, Luv Sharma, management science assistant professor, Carrie Queenan, management science clinical associate professor, and Orgul Ozturk, economics associate professor, wrote “The Impact of Information Technology and Communication on Medical Malpractice Lawsuits,” which has been accepted for a forthcoming edition of Production and Operations Management.
HIT encompasses everything from electronic medical records that manage patient data to insurance and billing processing. For Sharma, Queenan and Ozturk’s research, they focused on health care provider-specific technologies like the electronic medical record, which providers use to record patient vitals, lab results, imaging and health history, among other things.
The researchers extracted and analyzed all medical malpractice lawsuits filed against hospitals in Florida with more than 25 beds – 168 hospitals total – between 2007-2011. They chose Florida because the state provides more details about lawsuits in the public record, Sharma said.
They compared those lawsuits with the hospitals’ use of technology. They found when hospitals first implement new technology, they do see a reduction in malpractice suits. However, the more technology they adopt, the smaller the reduction in lawsuits, Sharma said.
“The positive of HIT is that it enables physicians to get data in real time from different sources,” he said. “When a patient is treated by multiple physicians in a traditional setting, the physician has to go to paper records. When they have [digital] access to the records, all of that patient’s information is available at the click of a button. It improves transparency and is a better overall integration of patient data.”
Additionally, patients receive results faster with digital records, Queenan added.
“As soon as a lab gets the results, the patients get their results,” she said.
While receiving results is much quicker, digital records have reduced the one-on-one time medical providers have with individual patients since they have to record more information in the electronic medical record.
With more technology, “eye contact is reduced, medical providers pay less attention to patients, and recent articles have documented an uptick in technology-related medical errors, which can actually increase malpractice lawsuits,” Sharma said.
These drawbacks to electronic records led the research team to examine the interaction between technology and communication.
They determined that hospitals who implement HIT with high communication quality are the ones with the least percentage of lawsuits.
When patients are released from the hospital, they are given a survey with questions about how well and how often their physician and nurse communicated with the patient, Queenan said.
They averaged these survey results for every hospital to measure their communication quality and cross referenced these with the percentage of lawsuits as well as the timeline for their HIT implementation.
“The results are a non-linear model,” Sharma said. “You see the differential impacts of communication and technology at different levels. You actually see a disproportionate higher reduction in early levels of HIT – the earliest HIT adoptions find the biggest decrease in lawsuits.”
When a hospital has high communication quality as they increase their technological infrastructure, there are fewer lawsuits. Adversely, when they have poor communication quality, there tend to be more lawsuits as they begin relying more heavily on technology.
“The implication is that if you don’t have good communication quality, if your physicians and nurses are not trained properly in how to communicate with patients, the increase in technology can have a negative impact” on lawsuits, Sharma said. “If patients are aware of things being done, of operational transparency, their satisfaction is higher.”
These patients whose physicians properly explain why certain tests are being administered, provide results in a timely and clear manner and promptly report back to the patient any diagnosis they’ve ruled out or confirmed are more likely to rate their medical provider with a higher communication score and are less likely to file a lawsuit.
The professors chose to look at the impact of HIT on lawsuits and subsequently communication quality’s impact on lawsuits because many hospitals – especially smaller ones – grapple with the costs associated with fully implementing HIT. Hospitals have to determine if the payoff to install expensive technology and train staff on new systems is worth the investment.
Queenan said numerous researchers have previously focused on the correlation between communication and lawsuits but have not examined the likelihood of lawsuits when introducing HIT.
“When HIT is coupled with good communication, good communication can be even better as there’s richer information in the HIT to relay to the patient,” she said. “You can’t just invest in HIT, you have to invest in training staff to properly communicate along with it to” potentially reduce lawsuits.
Reducing lawsuits are paramount for hospital administrators, Sharma said.
“A lot of money is spent in settling malpractice lawsuits,” he said. “There is also a psychological impact on physicians with lawsuits. Increasing technology and process communication will have a significant impact on reducing lawsuits.”
Sharma, Queenan and Ozturk are all continuing to study health care operations and policy and how technology can enable more efficient and effective care.