Malpractice Cases Involving Allergy Information in Electronic Health Records: Implications for Safer Systems Malpractice Cases Involving Allergy Information in Electronic Health Records: Implications for Safer Systems by Maxim Topaz, PhD, RN; Adam Schaffer, MD; Kenneth Lai, MSc; Zfania Tom Korach, MD; Jonathan Einbinder, MD; and Li Zhou, MD, PhD Abstract This study analyzed a large database of medical malpractice claims, focusing on allergy cases involving allergy health information systems that resulted in patients’ harm. The study consisted of a retrospective descriptive cohort analysis of malpractice claims in a large malpractice case repository representing about 30 percent of all the malpractice cases filed in the United States. Nine of 90 information technology malpractice cases (10 percent) were allergy cases. In one-third of the cases, allergy information systems were identified as the main cause of the malpractice issue. The main allegation category was medication related. Eight of the nine cases resulted in medium or high patient harm, and one case resulted in low patient harm. Although this study identified only a small number of cases, most of the cases resulted in medium or high patient harm. Our results highlight the critical need for safer and more interoperable allergy health information systems. Keywords: allergy and immunology; medical malpractice; electronic health records; quality and safety; alert fatigue Introduction and Background Health information technology, such as electronic health records (EHRs), has significantly changed the way patients are treated in modern healthcare settings. Almost every EHR system has a few clinical decision support functions that have been shown to improve the overall quality and safety of care. 1 For example, computerized physician order entry (CPOE), which helps medical practitioners to enter medications or other instructions for the treatment of patients, has reduced medical errors and has standardized medication prescription practices. 2, 3 A key element of CPOE is the allergy module that interacts with patients’ allergy lists within the EHR. These systems assess for cross-reactivity between prescribed medications and medications on the patient’s allergy list and, if necessary, generate drug- allergy interaction alerts. These allergy alerts help safeguard against prescription or administration of medications that could result in an allergy or other adverse reaction. In clinical practice, however, a growing body of literature shows that current allergy alerting systems have serious limitations, with providers overriding more than 90 percent of drug-allergy interaction alerts. 4–8 One study estimated that providers need to field more than 123 unnecessary alerts to prevent one adverse drug event. 9 This situation may contribute to provider alert fatigue and may make providers more likely to disregard critical alerts, possibly resulting in administration of contraindicated medication. A series of recent studies identified the central issues leading to high alert override rates (e.g., inaccurate or