Misinformation in electronic medical records has consequences

Electronic medical records have become an essential backdrop to modern medical practice. Paper charts, not long ago the mainstay of health-care documentation, have become antediluvian. Whereas once doctors used to write notes with pen and paper and insert the paper into a physical binder, doctors now keep track of patients by clicking keys on a keyboard and entering data into a computer software program.

One of the great advantages of the electronic medical record over its ancestral precursor :notes-in-a-binder” is that records are now centralized and can be accessed by multiple authorized care providers, such that it is possible to know what treatment a patient received from any health-care provider working in the conjoined medical system, from primary care visits to hospital admissions. Physicians are less siloed within specialties and more able to share information.

The Science section of the New York Times discusses the upsides and the downsides of modern technology in the medical workplace, but one of the downsides that isn’t emphasized is the fact that much of the data entered into electronic medical records is being mined to make important decisions about clinical care and health policy. And if data-mining is based on inaccurate information, then the whole operation is a house of cards. Let me cite one example.

A physician I know in Merced County, California has been practicing medicine for the greater part of three decades, and he was recently obliged by his medical group to transition from paper to electronic medical records. The medical-records software he uses mandates that he indicate on a pull-down menu the ethnicity of each of his patients. He views his patients’ ethnicity as non-essential to his practice, and so – pressed for time like most health-care providers - he clicks on “Albanian” for all of his patients, not because they are Albanian, but because “Albanian” is the very first item on the pull-down menu and therefore the fastest to access. The result is that over 90 percent of his patients appear to be Albanian, when in fact they represent the usual constituents of Merced County, with few if any Albanians among them.

Misinformation in electronic medical records, whether accidental or otherwise, has far-reaching consequences for patients and health care policy, because electronic medical records are being actively data-mined by large health care conglomerates and the government as a basis for improving care. This is an important downside to consider as we move forward.

Anna Lembke is Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.  She blogs at Scope.

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  • http://twitter.com/ChronoGeek Ellis Spanos

    Although I agree that it seems to be a silly thing to ask for the Ethnicity of the patient, for statistical reasons a MU certified EHR must have this in the demographics. Even so, the information should be entered correctly by the user to avoid this happening. Technology has brought us this far, a little tweek here or there to maybe reformat the list based upon the most commonly selected fields would solve this issue with the EHR in this example.

    • azmd

      The problem with your very excellent suggestion that the format be tweaked is this: once an EMR system is purchased, installed and the minimum training obligations are met, the vendor is supremely uninterested in “tweaking” anything to optimize the system in order to make it user-friendly for the specific customer. In a free market, these systems would not be adopted, since doctors would have the option to just not buy an EMR system until one was available that made sense to use. But we are not operating in a free market.

  • azmd

    This is an interesting article, but it fails to clarify what the reasons are, if any, that doctors should spend unpaid time functioning as data entry clerks so that the EMR may be be “actively data-mined by large health care conglomerates.” If the information is not clinically relevant, I can think of no good reason a doctor should be spending extra time collecting and entering it. But perhaps I am missing something here…

  • wahyman

    His friend who checks Albanian appears to be a real jerk. I would suggest leaving his practice. However patient acess might cure this particular brand of stupidity.

    • Southern doc1

      Why do you think the doc should waste his time doing something that does not benefit his patients or himself?

      • wahyman

        So that he doesn’t create the very misinformation that is being complained of, and because records are better if they are accurate rather than intentionally false.

      • wahyman

        So that he doesn’t create the very misinformation that is being complained of, and because records are better if they are accurate rather than intentionally false.

  • Ignacio Alvarez

    As ironic as it can sound, medical EHR was made to save time, cost and to reduce the number of medical errors. Yet, many companies who sell those EHR have forgot that technologies change behaviours. Many doctors are now accepting what is written in the electronic records as the truth without even reconfirming with their patient. Those changes in the behaviour have to be questioned and further EHR should be built consequently. (sorry for my english)

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