Thursday, September 24, 2009

Health Record Errors "above the fold"

September 2009. I have been a patient at my primary-care clinic for over 20 years. Finally the physicians have the benefit of electronic health records -- making them pioneers in Ontario. But the news is not necessarily good. My physician is young, articulate and totally computer literate. So that gives me a reasonable level of confidence. Still my record was full of errors to just the basics and that's cause for concern. This may well reflect the front office but what about the rest of the information that I don't fully understand? You decide.

Here's the story.

I had some lab tests scheduled for today and was provided with a printed requisition produced by my physician using the new EHR. I didn't read it until this morning - - -

On this, the appointed day, I called the clinic early to see what time the lab opens. I was hoping to be first in line. The clinic's office number was answered by an office unrelated to my clinic. When I pointed this out to admin staff, the office administrator was baffled and was keen on fixing it immediately. The phone number was in a header and, presumably, was wrong on every record in the office.

My name had two spelling errors. (What does the provincial insurer do with that?) On correction by the office administrator only one spelling error remained.

My phone number was changed some 5 years ago. Now its correct.

That's four errors and we are only just "above the fold" of my requisition.

This doesn't give me much confidence in the rest of the information. Just because the doctor's order was electronically requisitioned gives me no reason to believe its right. The lab technician did take a vial of blood as expected. I hope it will be used for the right tests.

Questions: Did the clinic follow a "change" protocol? Was anyone trained by the vendor? Are patients asked to check information about themselves? Is this a global problem? How serious are the patient safety implications? Will we now see wide spread errors caused by one wrong key stroke?

1 comment:

Ken Stevens said...

I think you are making the "slippery slope" logical fallacy here. The fact that lab req letterhead has an incorrect phone number or that your clinic's system had incorrect/outdated demographic data is commonplace and different in nature from the business of requesting a lab test. In the former case, it's reusing data from a potentially unreliable source. In the latter, a user is actively entering data for a point-in-time request. I would argue that electronic lab requisitions will statistically be more reliable, not less reliable than hand-written ones. For one, the electronic request will know which kinds of tests need to be performed in conjunction with what other kinds of tests, ensuring more consistency. And for another, handwriting, especially doctor's handwriting, is often ambiguous.