I keep talking about how integral social media is in healthcare, and how this is growing. This is just one more example in a long line of examples, and this time the focus is on electronic health records.
First, a little bit of background. Patients are often asked to tell their stories many times. The most important parts of their medical story are preserved in health records by the doctors and nurses, passed along from one to the next. Because patients may change how they tell the story from one telling to another, the healthcare providers often trust the health record as much or more than what the patient tells them today. However, sometimes the story is written down missing important parts, or wasn’t understood properly, or is flat out wrong, perhaps mixed up with another patient or through typos. Basically, sometimes there are mistakes in medical records, and sometimes those mistakes can contribute to mistakes in the treatment a patient receives. That’s bad. Very bad, sometimes.
There are a lot of stories from the patient side about finding challenges, confusions, and errors in medical records, and what that meant. On the provider side, there are a lot of research studies about medical records and errors. Here are just a few of each.
PATIENTS’ STORIES (CLASSICS)
Eve Harris. Medical Records, Yours, Mine, and Ours: http://eve-harris.blogspot.com/2009/10/medical-records-yours-mine-and-ours.html
ePatient Dave. Imagine someone had been managing your data, and then you looked: http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html
Doc Searls. Patient as Platform. http://www.linuxjournal.com/content/patient-platform
PROVIDER STUDIES (RECENT)
TJ Cheng, et al. (July 2012) Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan: http://www.ncbi.nlm.nih.gov/pubmed/22855626
“About one-fifth issued death certificates sustained improper COD statements and only one-tenth had noteworthy errors that would threaten the quality of COD statistics”
A Hooft, et al. (July 2012) Identification of Physical Abuse Cases in Hospitalized Children: Accuracy of International Classification of Diseases Codes: http://www.ncbi.nlm.nih.gov/pubmed/22854329
“In 133 cases of suspected child physical abuse, the sensitivity and specificity of ICD-9-CM codes for abuse were 76.7 % (CI 61.4%, 88.2%) and 100% (CI 96.0%, 100%), respectively. Analysis of the 10 cases of abuse not receiving ICD-9-CM codes for abuse revealed that errors in physician documentation (n = 5) and in coding (n = 5) contributed to the reduction in sensitivity. Despite high specificity in identifying child physical abuse, the sensitivity of ICD-9-CM codes is 77%, indicating that these codes underestimate the occurrence of abuse.”
A Ekedahl, et al. (November 2011) Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients: http://www.ncbi.nlm.nih.gov/pubmed/21858899
“More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%.”
AMA. (January 2012) Safety research found lacking for outpatient visits: http://www.ama-assn.org/amednews/2012/01/09/prl10109.htm
“Top six errors in outpatient care:
* Medication errors such as prescriptions for incorrect drugs or incorrect dosages.
* Diagnostic errors such as missed, delayed and wrong diagnoses.
* Laboratory errors such as missed, delayed and wrong diagnoses.
* Clinical knowledge errors such as knowledge, skill and general performance errors on the part of physicians and other clinicians.
* Communication errors such as doctor-patient communication errors, doctor-doctor communication errors or other miscommunications between parties.
* Administrative errors such as errors in scheduling appointments and managing patient records.”
PROJECT: WHAT’S IN YOUR HEALTH RECORD?
One idea for approaching the problem of errors in medical records is to engage patients, families, and caregivers in spotting and fixing the mistakes. This is such a powerful idea that the government has actually funded a challenge or contest with prizes for people to make videos on the topic.
What’s In Your Health Records Video Challenge: http://yourrecord.challenge.gov
“Do you know what’s in your health record? Share your story of why having access to review what’s in your health record can improve your quality of care, or the care of a loved one.”
What a really great amazing idea! Wonderful way to help make more people aware of the issues of errors in medical records. They are using social media to get the word out. They have a Twitter account, and an official Twitter hashtag for the contest – #YourHealthRecord. They require the videos to be submitted via Youtube or Vimeo. But I found out about the contest on Facebook.
Regina Holliday posted about the challenge several times in the Facebook group, Partnership with Patients.
Regina is quite a notable in the patient advocacy and participatory medicine movement, famous for her artwork in support of the movement and individuals active in it. She didn’t just bring this up once, either, but several times, with comments. She was very encouraging and supportive, urging people to make a video and tell their stories about medical records. She has her own powerful story, and had already made a video. I mentioned that I had a wild tale of my own. A few nudges, and I was thinking about it. But I’m extremely busy.
All of a sudden it was the NIGHT BEFORE THE DEADLINE. Uh oh. I didn’t look so great, was stressed, and tired, but if I was going to do it there was no other time. Tried three times, finally got it down (by telling the story with my college freshman across the table). Loaded it to Youtube, then tried to submit it, and found out I really should have read the requirements FIRST. Great goodness, there were so many requirements, and I didn’t feel capable of the smallest part of it.
But then folk offered to help. Regina said if I could edit it down to the two minute requirement and get it in Youtube, she’d make the transcript for me. I finished one version, and then discovered more requirements. Regina made the transcript, and I begged Marc Stephens for help with the titles. Eventually, with help, I finished it in time. So, what was my story? Here it is. (Transcript at Youtube.)
My medical record says WHAT???: http://yourrecord.challenge.gov/submissions/9720-my-medical-record-says-what