One in five patients report finding a mistake in their electronic health record (EHR), with 40 percent perceiving the mistake as serious, according to a new study published this week in JAMA Network Open.
The authors of the study are from Beth Israel Deaconess Medical Center in Boston, University of Washington Medicine in Seattle and Geisinger Health in Pennsylvania, three of the original health systems involved in the OpenNotes movement, designed to encourage sharing notes between patients and doctors. The researchers noted that as health information transparency increases, patients more often seek their health data. More than 44 million patients in the U.S. can now readily access their ambulatory visit notes online, and the practice is increasing abroad.
For this study, the researchers analyzed patient data collected from an online survey of nearly 23,000 patients in 2017 about their use of OpenNotes. Patients who had at least one ambulatory note and had logged onto the portal at least once in the past 12 months were included in the research. In total, 4,830 of 22,889 note readers—or 21 percent—perceived a mistake in their notes. And among those 4,830 patients who perceived mistakes in notes, 42 percent of them described the mistakes as serious, with 32 percent reporting the mistakes were somewhat serious and 10 percent noting they were very serious.
Of those “very serious” mistakes, the most common category of errors reported were those specifically mentioning the word diagnosis or describing a perceived error in current or past diagnoses (28 percent). Other very serious patient-reported mistakes included inaccurate description of medical history (24 percent); medications or allergies (14 percent); tests, procedures, or results ( 8 percent); and perceived errors pertaining to the physical examination, including elements of the examination that, according to the patient, were documented but not done (7 percent). Another 7 percent of patients described failed communication (issues that the practitioner documented as said or done but that the patient perceived did not happen at the visit), such as informed consent or counseling on specific topics, the data revealed.
According to the researchers, errors in electronic health records (EHRs) are common, pointing out that at least half of EHRs may contain an error, with many related to medications. They note that “overburdened practitioners may import inaccurate medication lists, propagate other erroneous information electronically by copying and pasting older parts of the record, or enter erroneous examination findings.” They point to separate research showing that among primary care physicians sharing notes with patients, about a quarter anticipated that patients would find nontrivial errors. “Despite these known problems, systems for checking the accuracy of notes are almost nonexistent. As practitioners integrate EHR data into decision-making, such errors could therefore lead to medication errors, wasteful duplication, unnecessary or incorrect treatment, and delayed diagnoses,” they stated.
The authors of the study did acknowledge multiple limitations, noting that just 22 percent of the more than 136,000 patients invited to take the survey responded. What’s more, they said, “Some patients do not have access to internet or data plans, patient portals, or notes, and results may not reflect the views of patients who do not have access to or do not read their notes online. True patient-reported EHR error rates could therefore be higher or lower than reported here,”
Nonetheless, they concluded, “The findings suggest that inviting patients to report perceived mistakes in shared visit notes, particularly those that patients believe are very serious, may be associated with improved record accuracy and patient engagement in diagnosis. Developing efficient mechanisms to respond to such reports appears to be important.”
