Database design to ensure anonymous study of medical errors: a report from the ASIPS Collaborative

Abstract

Medical error reporting systems are important information sources for designing strategies to improve the safety of health care. Applied Strategies for Improving Patient Safety (ASIPS) is a multi-institutional, practice-based research project that collects and analyzes data on primary care medical errors and develops interventions to reduce error. The voluntary ASIPS Patient Safety Reporting System captures anonymous and confidential reports of medical errors. Confidential reports, which are quickly de-identified, provide better detail than do anonymous reports; however, concerns exist about the confidentiality of those reports should the database be subject to legal discovery or other security breaches. Standard database elements, for example, serial ID numbers, date/time stamps, and backups, could enable an outsider to link an ASIPS report to a specific medical error. The authors present the design and implementation of a database and administrative system that reduce this risk, facilitate research, and maintain near anonymity of the events, practices, and clinicians.

Figure 1.

ASIPS confidential reporting Web form.

Figure 2.

Schematic of linking tables for error code objects to practices and time frames.

Figure 3.

Database structure for selected tables with the ASIPS database.

Figure 4.

The data management process for reports to ASIPS involves many steps, most of which are time-limited. An event report may move through these steps in many different pathways.

Figure 5.

Simplified representation of error code objects from a coded event.