Death By 1,000 Clicks: Where Electronic Health Records Went Wrong

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Kaiser Health News and Fortune Magazine collaborated on this joint investigation for three months. Fred Schulte is a senior correspondent for KHN. Erika Fry is an investigative reporter for Fortune. Only certain images can be republished by partners. The pain radiated from the top of Annette Monachelli's head, and it got worse when she changed positions. It didn't feel like her usual migraine. The 47-year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief. Two months later, Monachelli was dead of a brain aneurysm, a condition that, despite the symptoms and the appointments, had never been tested for or diagnosed until she turned up in the emergency room days before her death. Monachelli's husband sued Stowe, the federally qualified health center the physician worked for. Owen Foster, a newly hired assistant U.S. attorney with the District of Vermont, was assigned to defend the government. Though it looked to be a standard medical malpractice case, Foster was on the cusp of discovering something much bigger -- what his boss, U.S. Attorney Christina Nolan, calls the "frontier of health care fraud" -- and prosecuting a first-of-its-kind case that landed the largest-ever financial recovery in Vermont's history. Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses -- thousands of them -- tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety. Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." Some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software makers have paid a total of more than $200 million to settle fraud allegations. Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the country.