Medical risk management faces a highly uncertain future. Due to the increase in litigation in U.S. society, medical claims frequency is up slightly while claims severity has increased sharply. Consequently, risk managers in the medical field must help their institutions develop ways to improve the efficacy of treatment. One signal development in the medical field is the availability of health care information through a wide array of computer programs. This medical information spans many disciplines, and includes patient demographics, utilization, clinical records, payment status, and other sensitive information that can be accessed by myriad users, including health care providers, quality improvement personnel, utilization and claims managers, researchers, public health representatives and patients.
What is the likely impact of computerization on the liability risk exposure of care providers and institutions? A number of studies show that these programs have resulted in improvements in medical diagnoses and treatment and, hence, a reduction in liability claims.
Malpractice Claims Profile
Before examining computer applications, one needs to take a look at the type and frequency of claims that are prevalent in the medical field. In the mid-1980s, a study by the General Accounting Office was conducted to determine the amount and frequency of medical claims. The study stratified the 102 medical malpractice insurance carriers in the United States by type of insurer and rank-ordered them by premium volume, with larger companies having a greater probability of selection. From this pool of insurers, 25 firms were randomly selected to participate in this study. Each of these companies provided a listing of claims and indemnity payments for all claims closed in 1984, yielding a total of 73,472 claims.
The claims were analyzed by the type of treatment error, and the number and amount of indemnity payments as shown in Table 1. The type of facility where the injury occurred is shown in Table 2, which reveals that the great majority of injuries took place in the hospital. The survey demonstrates that medical claims are a significant problem in the various branches of the medical field; the following is an overview of how computer applications can be used to reduce the liability claims listed in Table 1.
The first of these areas is anesthesia. The introduction of anesthesia practice guidelines in the mid-1980s had a pronounced effect on reducing malpractice claims. In particular, these minimal monitoring standards have resulted in wider use of pulse oximetry technology, which measures the oxygen content in arterial blood, thereby improving the quality of anesthesia. However, a large class of claims related to anesthesia has resulted from cases where the anesthetist did not take a complete medical history of the patient. In particular, failure to identify a prior history of angina, myocardial infarction, recent upper respiratory infection, and asthma can predispose certain patients to intra-operative respiratory problems and cardiac arrest. A number of studies reported in medical journals have shown that compared with the traditional history-taking approach, computer applications result in more accurate information and have less variability in the listing of correct data.
Diagnostic errors are the second type of claim listed in Table 1, and represent the largest category of malpractice claims against physicians in general, and primary care physicians in particular. A number of computer-based diagnostic aids exist to reduce these errors. Most commonly, the clinician enters a series of signs and symptoms into the program, which results in the narrowing of the differential diagnosis to the point where the clinician can reach the final diagnosis. The more sophisticated versions of these programs present additional diagnostic information, including summaries of the etiology, symptoms, physical findings, laboratory findings, X-ray results and other factors. …