A row of colored medical records folders

The Troubling Prevalence of Medical Record Errors

With plenty of potential healthcare concerns and complications arising out of medical diagnoses and treatments themselves, errors in medical records present an unfortunate additional opportunity for improper treatment.

A recent article from Kaiser Health News (KHN) discussed several examples of dangerous medical record errors: a hospital pathology report identifying cancer that failed to reach the patient’s neurosurgeon, a patient whose record incorrectly identified her as having an under-active rather than overactive thyroid, potentially subjecting her to harmful medicine, and a patient who discovered pages someone else’s medical records tucked into in her father’s records. In addition to incorrect information, omitting information on medications, allergies, and lab results from a patient’s records can be quite dangerous.

The goal of “one patient, one record” provides a way to “bring patient records and data into one centralized location that all clinicians will be able to access as authorized.” This enables providers to better understand the full picture of a patient’s medical condition. It also minimizes the number of questions, and chances of making errors, that a patient must answer regarding their medical conditions and history when they visit a provider.

Other benefits, such as cost and care coordination, also add to the appeal of centralized records.

Streamlined electronic health record systems can minimize the risk of error due to having medical information for one patient in different places. The Logansport Memorial Hospital in Logansport, Indiana, for example, recently announced plans to put a single record system in place by 2020, replacing the two separate systems—one for acute services and another for physicians—it currently has in place.

However, the importance of recording the correct information is perhaps amplified with centralized systems: if an error is made in one place, that error is then replicated throughout the system, putting patients at risk.

And as data sharing increases, there’s plenty of room for error in consolidating patient information, due to different systems’ mechanisms for information protection, sharing, storage, and classification. In addition, repeated care due to duplicate records can be quite costly.

According to Doug Brown, Managing Partner of Black Book Research, “increased risk and cost from redundant medical tests and procedures because of fragmented data trapped in silos makes tracking patients especially difficult.” Translating paper records into electronic versions, and transcription or data input mistakes also pose risks of incorrect medical records.

According to the Patient Safety Authority of Pennsylvania, 889 medication-errors in which health information technology (HIT) was a contributing factor were reported in the first half of 2016. These errors were largely related to dosages (such as omitted doses or overdosages).

And with errors underreported, the potential harmful impact of medical record errors could be even greater than the study revealed.

Estimates by the Office of National Coordination for Health Information Technology (ONC), based on information from a 2017 survey, found almost 1 in 10 individuals who accessed their medical record online requested that information in their record be corrected. The ONC brief found that 28 percent of individuals nationwide viewed their medical record online in the past year. This leaves open the possibility of many undiscovered errors among the 72 percent who did not view their online medical health records.

On the bright side, the ONC brief found that 8 in 10 of those who did access their medical record online found it to be useful and easy to understand. But unfortunately, obtaining medical records can itself be a challenge. A recent study of 83 US hospitals found a number of issues, including costs for release higher than federal recommendations, processing times above state requirements, and discrepancies between information given over the phone by medical records departments and information on medical record release authorization forms.

These problems resulted despite protections under the  Health Insurance Portability and Accountability Act of 1996 (HIPAA), which gives patients the right to request to see and get a copy of their health records and the right to correct health information. Under HIPAA, the record must also be provided at a reasonable cost, within 30 days of the request’s receipt, and in the requested format, if possible. But even with these protections in place, confusion and challenges in accessing medical records are still present.

While there is clearly room for improvement in accessibility of medical records, knowing the rights patients have with respect to medical records, reviewing records carefully, and requesting corrections of any errors will help patients defend themselves from harms of medical record errors.

And in addition to enabling patients to identify and hopefully correct incorrect medical records, reviewing medical records can hopefully produce other benefits as well. Research has demonstrated that reviewing medical records increases the likelihood that patients will follow treatment recommendations and feel that they’re engaged in their care.

 

Rebecca Friedman is a 2018-2019 Petrie-Flom Center Student Fellow. 

Rebecca Friedman

Rebecca Friedman

Rebecca Friedman is in her third year at Harvard Law School and is a current Petrie-Flom Center Student Fellow. She plans to pursue a fellowship after law school in which she will advocate for fair access to quality healthcare and will provide direct representation for Medicaid beneficiaries to assist them in obtaining healthcare coverage and essential services. For her research project, Rebecca will study the potential for Medicaid to cover doula services, and the possible impact that could have on minimizing racial and socioeconomic disparities in prenatal care and childbirth.

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