Minimizing electronic health record patient-note mismatches

Abstract

We measured the prevalence (or rate) of patient-note mismatches (clinical notes judged to pertain to another patient) in the electronic medical record. The rate ranged from 0.5% (95% CI 0.2% to 1.7%) before a pop-up window intervention to 0.3% (95% CI 0.1% to 1.1%) after the intervention. Clinicians discovered patient-note mismatches in 0.05-0.03% of notes, or about 10% of actual mismatches. The reduction in rates after the intervention was statistically significant. Therefore, while the patient-note mismatch rate is low compared to published rates of other documentation errors, it can be further reduced by the design of the user interface.

Figure 1

Intervention pop-up window. The top of the note editing screen always displayed the medical record number, name, gender, and date of birth. The intervention added a pop-up window (center) that reiterated the name and medical record number when a note was submitted. (A fictional patient is shown.)

Figure 2

Monthly rate of mismatches before and after intervention. The rate of clinician-reported patient-note mismatches (block note requests) and the estimated rate of gender mismatches (parser positive rate) are shown for the months preceding and following the intervention.