Background: Wrong-patient order entry errors are common and often have the potential to cause patient harm. The Office of the National Coordinator for Health Information Technology Patient Identification SAFER Guide recommends displaying patient photographs in Electronic Health Records (EHRs) to reduce wrong-patient errors; however, only a small proportion of hospitals nationally utilize patient photographs. A perceived barrier to implementation is patient refusal to be photographed, though there is no research that examines how patients view this intervention. Our study aims to determine the rate of patient photograph refusals and to gather qualitative feedback from patients on having their photograph taken and integrated into the EHR.
Methods: The study was conducted at emergency department (ED) and outpatient facilities within a large integrated health system in New York City. The study sites are located in a diverse neighborhood, where 71% of the population is Hispanic, 7% African American, and 48% foreign born. Observations of patient registration encounters were performed by a medical student in an ED and an outpatient primary care clinic. Data were collected from a convenience sample of patients who had a complete registration between August 23 and September 19, 2018. Complete registrations were defined as registrations in which the hospital policy was followed, including asking the patient to be photographed. Patients’ acceptance or refusal to have a photograph taken for patient identification in the EHR was captured at both study sites. In addition, in the emergency department, a separate convenience sample of patients was interviewed in a standardized fashion which included both open-ended questions to address perceived benefits or concerns about photographs in the medical record, as well Likert scale style questions to obtain qualitative feedback on the patient photograph implementation process.
Results: Of a total of 113 complete registrations, zero refusals were observed in the ED (0/87), and an outpatient primary care clinic (0/26) for a total refusal rate of 0/113. Of the 15 patients who were interviewed in the Emergency Department, 66.7% (10/15) said they understood the purpose of patient photographs in the EHR; 100% (15/15) agreed or strongly agreed that the photograph would help their provider identify their chart in the EHR. Additional perceived benefits included improved security, and faster registration. Only 2 of 15 patients voiced concerns, which included the government using the information and invasion of privacy.
Conclusions: In a diverse, inner-city neighborhood, patient refusals were not found to be a barrier to implementation of patient photographs in the EHR for the reduction of wrong-patient errors.