Report: Correlation between missing data, medical errors

A JAMAstudy showed that clinical information wasn't complete in 13.6% of patient visits studied.

By Andis Robeznieks — Posted Feb. 21, 2005

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One result of the health care system using more specialists to take care of sicker patients is that physicians are often missing important pieces of clinical information, and there is a concern that this could lead to medical errors, delays in treatment or duplication of services.

According to a report published in the Feb. 2 Journal of the American Medical Association, clinical information such as laboratory and radiology results, letters and medical history was missing during 13.6% of 1,614 patient visits analyzed by researchers at 32 Colorado primary care clinics.

The study, funded by the American Academy of Family Physicians and the Agency for Healthcare Research and Quality, also found that, in 44% of these cases, doctors felt that the missing information had the potential to adversely affect a patient's well-being.

"Patients are getting a lot of care at a lot of places," said the study's lead author, Peter C. Smith, MD, an assistant professor of family medicine at the University of Colorado at Denver and Health Sciences Center. "Missing information is a symptom of a sick health care system -- and it shows it really isn't a system. It's a bunch of independently acting units."

Dr. Smith said physicians with "full" electronic medical record systems were less likely to report episodes of missing information. But he noted that, within a few of the same practices, some doctors reported having only partial systems and reported more cases of missing data.

Dr. Smith said this suggested that doctors who are less familiar with the workings of an EMR system might not be getting full use of that system.

Citing research indicating that more than 15% of medical errors in the primary care setting are associated with missing clinical information, Dr. Smith noted the importance of making the patient -- or the patient's family -- part of the health care team.

"This is a good opportunity for families to watch out for each other," he said. "It's a team effort, and we're all working together to make care better and safer."

An editorial that accompanied Dr. Smith's report agreed. Co-written by John Hickner, MD, a professor of family medicine at the University of Chicago Pritzker School of Medicine, it suggests giving copies of reports to patients that they can bring with them to hospital emergency departments or to other specialists. The editorial also suggests that staff screen charts to make sure files are complete before patients arrive.

"It really shouldn't be the physician's direct responsibility to make sure that information is there, but ultimately, it's their responsibility," Dr. Hickner said. "Physicians have to show leadership and say, 'This is how it has to be,' and then there has to be a system in place to get it done."

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What's missing?

Missing clinical information has been associated with medical errors in primary care. In a recent study, physicians and other health care professionals reported that they were missing some piece of clinical data during 13.6% of patient visits. The missing information fell into the following categories:

Category Percent
of visits
Laboratory results (blood chemistry,
urinalysis and hematology)
Letters/dictation 39.5%
Radiology results 28.2%
History and physical exam 26.8%
Current and prior medications 23.2%
Pathology results (biopsy specimens
and cytology)
Immunization records 12.3%
Procedures 7.3%
Other 5.0%

Note: Some respondents indicated missing data from more than one category during a single visit, so percentages total more than 100. Source: Journal of the American Medical Association, Feb. 2

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External links

"Missing Clinical Information During Primary Care Visits" abstract, Journal of the American Medical Association, Feb. 2 (link)

"I Wish I Had Seen This Test Result Earlier!" abstract, Archives of Internal Medicine, Nov. 8, 2004 (link)

"Tracking Test Results Within a Physician Practice," Kentucky Medical Assn. Patient Safety Task Force, 2004, in pdf (link)

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