Sigall K. Bell|Thomas L. Delbanco|Joann G. Elmore|Patricia Fitzgerald|Alan Fossa|Kendall Harcourt|Suzanne G. Leveille|Thomas H. Payne|Rebecca Stametz|Jan Walker|Catherine M. DesRoches
Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes
Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|University of California, Los Angeles|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|University of Michigan–Ann Arbor|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Harvard University|University of Massachusetts Boston|University of Washington|Geisinger Health System|Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University
h3importanceh3 health information transparency increases patients often seek health data 44 million patients us readily access ambulatory visit notes online practice increasing abroad studies assessed documentation errors patients identify notes may inform patient engagement safety strategies h3objectiveh3 assess frequency types errors identified patients read open ambulatory visit notes h3design setting participantsh3 survey study total 136 815 patients 3 us health care organizations open notes including 79 academic community ambulatory care practices received invitations online survey june 5 october 20 2017 patients least 1 ambulatory note logged onto portal least past 12 months included data analysis performed july 3 2018 april 27 2020 h3exposuresh3 access ambulatory care open notes patient portals 7 years 20102017 h3main outcomes measuresh3 proportion patients reporting mistake serious perceived mistake factors associated finding errors characterized patients serious categories patientreported errors h3resultsh3 136 815 patients received survey invitations 29 656 217 responded 22 889 patients mean sd age 5516 1596 years 14 447 631 female 18 301 800 white read 1 notes past 12 months completed error questions patients 4830 211 reported perceived mistake 2043 423 reported mistake serious somewhat serious 1563 324 serious 480 99 multivariable analysis female patients relative risk rr 179 95 ci 172185 educated patients rr 138 95 ci 129148 sicker patients rr 189 95 ci 184194 aged 45 64 years rr 223 95 ci 206242 65 years older rr 200 95 ci 173232 read 1 note 23 notes rr 182 95 ci 134247 4 notes rr 309 95 ci 202473 likely report mistake found serious compared reference groups categorization patientreported serious mistakes specifically mentioning wordidiagnosisior describing specific error current past diagnoses common 98 356 275 followed inaccurate medical history 85 356 239 medications allergies 50 356 140 tests procedures results 30 356 84 total 23 65 reflected notes reportedly written wrong patient 433 serious errors 255 589 included least 1 perceived error potentially associated diagnostic process eg history physical examination tests referrals communication h3conclusions relevanceh3 study patients read ambulatory notes online perceived mistakes substantial proportion found serious older sicker patients twice likely report serious error compared younger healthier patients indicating important safety quality implications sharing notes patients may help engage improve record accuracy health care safety together practitioners