Assessment of Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey

Abstract

Background Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.

Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study

“…A growing body of evidence supports providing patients access to their electronic health records to improve several aspects of quality of care, including patient safety [ 1 - 3 ], patient-centeredness [ 4 , 5 ], and effectiveness [ 3 ]. Patient portals are currently recognized as a promising mechanism for improving health care data sharing with patients.…”

“…If a patient’s primary care practice has signed up, data such as allergies, medications, and diagnoses will also be visible to them. Patients may access their records whenever they wish to review information or when notified about new information, such as available test results [ 3 ].…”

Prevalence and Factors Associated with Patient-Requested Corrections to the Medical Record through Use of a Patient Portal: Findings from a National Survey

“…Indeed, prior U.S. and European studies have identified medical terminology as one impediment to patients' understanding of their records. 13 39 40 41 42 43 44 45 Patients with lower education may also be less likely to be engaged in shared medical decision-making with their clinician, 46 which may suggest a lower likelihood of reporting errors. However, in our study, we did not find education level to be a predictor of requesting corrections to medical records.…”

“…Furthermore, some U.S. and European studies have reported higher rates of error perception (12–38%) among patients when reading their records. 12 39 44 47 48 The discrepancy between error perception and formally requesting corrections by the health system may be partly explained by patients who may be experiencing challenges with navigating processes for requesting corrections, 11 44 patients who may not perceive the error to be serious enough to warrant formal actions, 44 or patients who may be hesitant on potential adverse effects on their relationships with their clinician or staff. 49 Furthermore, some correction requests may not be clinically or ethically appropriate to complete.…”

Patients’ Willingness and Ability to Identify and Respond to Errors in Their Personal Health Records: Mixed Methods Analysis of Cross-sectional Survey Data

“…Errors in electronic health records (EHRs) are not uncommon and are known to contribute to patient safety incidents [ 1 ]. Up to 60% of patient records may include inaccuracies or omissions, such as errors in patients’ diagnoses, medical history, medications, allergies, test results, procedures, contact information, and appointment details [ 2 - 6 ]. Early EHR systems largely reflect traditional paper–based records with records containing large amounts of unstructured free text stored in a digital format.…”