Putting children’s photos in their electronic hospital charts could help reduce one type of medical error, a study published Monday suggests.

Policymakers have been pushing hospitals and doctors to replace old-fashioned paper records with electronic ones. The goal is to improve the quality of people’s medical care - which includes preventing errors.

But e-records have not eliminated human error. And in some cases, hospital patients may get a test or treatment intended for someone else because the doctor mistakenly put an order in the wrong electronic chart.

In 2009, a quality-improvement program at Children’s Hospital Colorado found that such misplaced orders were the second-most common reason that patients received care not meant for them.

“We were surprised by that,” said Dr. Daniel Hyman, the chief quality officer at the Aurora, Colorado, hospital and lead researcher on the new study.

Doctors may put an order in the wrong record if, for instance, they have multiple records on their screen at a time. “You can think you’re in one person’s chart, but really be in someone else’s,” Hyman explained.

To help cut those types of errors, the hospital changed its computer system so that each order for a test or treatment triggered an “order verification screen,” which included a photo of the child in question.

And the move seems to have paid off, Hyman’s team reports in the journal Pediatrics.

In 2010, the hospital had 12 incidents in which a child received care intended for another patient because of misplaced orders. One year later, that number had fallen to three.

And in all three of those cases, the child had no photo in his or her record.

There were also 10 “near-miss” cases in 2011 - where a treatment or test was ordered for the wrong patient, but another staff member caught it. That was down from 33 near-misses the year before. And in only one of those 10 cases did the child have a photo in the medical record.

“I do think it’s the photos that made the difference,” Hyman said.

SMALL NUMBERS ADD UP

Of course, misplaced orders are only one source of medical error. And the 12 incidents at this hospital in the pre-photo year may not sound like a big number, Hyman said. (The center admits about 13,500 patients each year.)

But those numbers would add up if you consider all hospitals across the country, Hyman pointed out.

There’s actually little known about how often doctors put orders in the wrong e-record.

One study found that doctors place 0.3 percent to 0.5 percent of “clinical notes” in the wrong electronic record - but those notes refer to information on patients’ health, and not orders for tests or treatment.

Hyman said it would be feasible for other hospitals to add photos to their electronic records. The Colorado hospital did it by using digital cameras to take children’s photos when they were admitted to the center.

“The technology needed is relatively inexpensive,” Hyman said.

One issue that can come up, he noted, is that parents sometimes do not want their child’s picture taken. “Some parents don’t want it because of privacy issues,” Hyman said. “But they should know that we’re doing it for their (children’s) safety.”

He said the findings also highlight the bigger picture: even when electronic records are in place, errors still happen.

“Patient identification errors are a significant risk,” Hyman said. “And I think healthcare consumers should be aware of that.”

He suggested that if your child is in the hospital, you should make sure you understand the general treatment plan. Then if, for example, staff comes to give your child medication you were not aware he would be getting, you can speak up.

“You should feel comfortable asking questions,” Hyman said.

SOURCE: Pediatrics, online June 4, 2012.

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The Use of Patient Pictures and Verification Screens to Reduce Computerized Provider Order Entry Errors

RESULTS: For the year before the interventions described herein, placement of orders in the incorrect patient’s chart was the second most common cause of care being provided to the wrong patient, comprising 24% of the reported errors. In the 15 months after the implementation of an order verification screen with the patient’s photo centrally placed on the screen, no patient whose picture was in the EMR was reported to have received unintended care based on erroneous order placement in his or her chart.

CONCLUSIONS: The incorporation of patient pictures within a computerized order entry verification process is an effective strategy for reducing the risk that erroneous placement of orders in a patient’s EMR will result in unintended care being provided to an incorrect patient.

  Daniel Hyman, MD, MMM,
  Mariel Laire, BA, MBA,
  Diane Redmond, MSN, CPHQ, RN, and
  David W. Kaplan, MD, MPH