School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States.
Informatics-Review LLC, Lake Oswego, Oregon, United States.
Appl Clin Inform. 2023 Mar;14(2):290-295. doi: 10.1055/a-2018-9932. Epub 2023 Jan 27.
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.
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.
Based on literature review and experience reviewing cases, we identified seven criteria to help in this assessment.
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.
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.
医疗保健领域正在广泛采用电子健康记录（EHR）。新的医疗专业责任（即医疗事故）案件可能涉及从 EHR 中提取的数据以及 EHR 工作流程、审核日志，甚至 EHR 造成伤害的潜在作用的审查。
由于打印版与屏幕显示版本之间的差异、冗余以及打印输出通常按文档或信息类型而不是按时间顺序分组的方式，查看患者的 EHR 打印版本可能会很困难。仅仅重现准确的时间线通常需要具有设计、开发、使用和审查 EHR 和审核日志方面的培训和经验的专家。如果出现有关数据含义、完整性、准确性和及时性的问题，或者有关 EHR 用户界面或自动化临床决策支持工具如何导致指控事件的问题，则需要额外的专业知识。此类专家通常来自临床信息学的社会技术领域，该领域研究信息和通信技术的设计、开发、实施、使用和评估，特别是 EHR。确定有资格协助法律团队的合格 EHR 专家具有挑战性。
根据文献综述和案例审查经验，我们确定了七个标准来帮助进行这种评估。
这些标准是临床信息学教育；临床信息学知识；EHR 设计、开发、实施和使用经验；沟通技巧；临床信息学方面的学术出版物；临床信息学认证；以及参加与信息学相关的专业组织。
虽然这些标准都不是必需的，但了解个人在这些领域的资格的广度和深度可以帮助识别高质量的临床信息学专家证人。
