Minimizing Electronic Health Record Patient-Note Mismatches

This is a review of Wilcox, Chen, and Hripcsak's 2011 article, Minimizing Electronic Health Record Patient-Note Mismatches.

Summary

The authors of the article wanted to reduce the occurrence of clinicians documenting notes on the wrong patient’s electronic chart, which they referred to as “patient-note mismatch.” They learned about these mismatches from physician self-reports. The authors needed to measure the occurrence of these mismatches, so they decided that a discrepancy between the patient’s listed gender and the gender mentioned in an admission note would be a good indicator of a mismatch. To decrease the occurrence of patient-note mismatches, they designed a dialogue box that would pop up and ask the physician to verify that they are saving the note on the correct patient. It prompts them to reenter their password as a method of confirmation. This change in the user interface decreased the amount of mismatches from 0.5% to 0.3%.

Comments

The introduction of a confirmation dialogue box was an effective workflow change that resulted in the reduction of the amount of note mismatches. However, I believe that asking for the user’s password as a means of confirmation is more than what is necessary. As an analogy, online banking does not ask for your password every time you make an online transaction. But as the author stated, the screen where clinicians write their notes in the electronic medical record is separate from the interface for viewing patient data, therefore there is no visual as to which patient they are documenting on. A better interface is one where the patient’s picture and/or demographics is visible on all pages, i.e., name and medical record number can be seen on the top left of each page.