Patients care may be adversely affected by missing information in as many as 220 million patient visits each year, according to a study published by the Journal of the American Medical Association this week. Electronic medical records alleviate but do not solve the problem.
Though missing information is blamed in about 16 percent of medical errors, this is the first survey to document how frequently primary care clinicians lack information during office visits. Information was missing in one of seven visits. Clinicians estimated that the missing information was likely to adversely affect the patients medical care and could cause delayed care or redundant services 60 percent of the time. In 45 percent of the visits, the clinician reported spending five or more minutes unsuccessfully searching for the information, time that could have been spent with the patient.
Only about 7 percent of physicians, physicians assistants, and nurse practitioners reported having full EHRs (electronic health records), but this group was 60 percent more likely to have complete information. Doctors offices in rural areas, which tend to rely on a smaller number of vendors for laboratory results, were 48 percent more likely to have complete information.
Don Mon, vice president of practice management at the American Health Information Management Association, said that clinicians with EHRs probably had more complete information because the system actively prompts physicians to collect information.
Clinicians reported that most (52.3 percent) missing information was outside the medical practice but inside the United States. However, information was just as likely to be missing if a practice had electronic access to a primary hospital.
Nevertheless, Mon said that the study pointed to the need for a national health information network so that different systems could communicate. "Hospitals might have an electronic record and a physician might have an electronic record, but we dont have the means to exchange them. They are acting like islands."
In an editorial accompanying the study in the JAMA, Nancy Elder and John Hickner wrote, "There are thousands of electronic databases, even within the same community, that cannot communicate with each other." In addition, clinicians who reported having hybrid or partial EHRs were just as likely to have missing information as those without such systems.
New patients were more than twice as likely to have missing information as patients who were returning to the same doctors offices. Information was three times more likely to be missing for patients with five or more medical problems, and 80 percent more likely to be missing for recent immigrants.
The survey did not ask clinicians whether any information was missing, but asked specifically whether information important for patient care and known to exist was missing during the visit. Information that was not in a patients file when a doctor visit began was not counted as missing if it was located before the visit ended. In 36 percent of visits with missing information, clinicians or staff had spent more than five minutes looking for information while the patient was in the office.
The survey, led by Peter Smith at the University of Colorado Health Sciences Center, was conducted for 1614 visits with 253 physicians, physicians assistants or nurse practitioners at 32 clinics. Laboratory results were reported missing most often, in about 6 percent of visits, followed by letters and dictations, history and physical examinations, radiology results and medications.