Background: Duplicate medical records, where one patient possesses multiple medical record numbers and corresponding charts within a single electronic health record (EHR), pose significant patient safety risks due to incomplete data and repeated interventions, among other areas. The risk is amplified for patients admitted to the hospital, where rapid pace decision making is the norm. Mitigating this risk requires that health systems work to reduce the creation of duplicate charts, identify these charts when they exist, and consolidate charts in a timely manner. We aimed to understand care team members’ perceptions of duplicate charts and the current process for consolidating charts in the inpatient setting.
Methods: Using the EHR’s native analytics tool, we identified patients from the past 6 weeks who possessed multiple charts during their hospitalizations. Nurses, advanced practice providers, residents, attending physicians, and pharmacists who cared for these patients were eligible for the study. Individuals from each key informant group were randomly selected and approached for interviews via email. Semi-structured interviews were conducted by one of three team members either in-person or over video conference and were audio recorded. Interviews were summarized into detailed field notes, and key informant profiles were compiled using the Jobs, Pains, and Gains framework from the Value Proposition Canvas (1).
Results: During the study, 25% of patients hospitalized at our institution possessed multiple medical records. The interview offer email response rate was 50% (17 of 34). Fifteen individuals completed interviews, including between 2 and 4 from each key informant group. Interviewees noted not always being aware of patients having duplicate charts, with easy to miss indicators on the EHR. When aware of the second chart, all interviewees perceived an expectation to reference the other medical record regularly and to consolidate findings into care plans and documentation. This greatly contributed to cognitive load. They also discussed the challenge of toggling between multiple charts and spoke of the time and number of clicks required to do so. Interviewees noted patient safety concerns related to missing key information, especially for medically complex patients. They stressed the importance of systematic improvement efforts to reduce duplicate chart creation. Interviewees reported limited knowledge of the current inpatient chart consolidation process. When informed of the process, which requires a brief period without chart access and the re-entering of active orders following consolidation, they shared heightened patient safety concerns related to order re-entry. They emphasized the importance of patient selection, timing, and team roles in the inpatient duplicate chart consolidation process.
Conclusions: Duplicate charts are unfortunately common, however indicators of duplicate charts are not always obvious within the EHR. Care team members of varying roles consistently perceive an expectation to reference secondary medical charts, which involves many clicks, time, and heightened cognitive load. Concerns arise about the safety of patient care when duplicate records are present. However, safety concerns also exist related to the current chart consolidation process at our institution. Improvement efforts to decrease duplicate chart creation and to ensure safe and efficient consolidation of medical data are critically important for safe patient care.