The People's Perspective on Medicine

Why Do Electronic Health Records Have So Many Mistakes?

Do you read your electronic health records? Most people don't. The really important information is likely missing unless the health system offers OpenNotes.
Doctor using laptop and electronic medical record (EMR) system. Digital database of patient’s health care and personal information on computer screen. Hand on mouse and typing with keyboard.

Every once in a while we write an article that creates a firestorm of controversy. Such was the news story about electronic health records (EHRs). We never imagined that people would be so upset about gaining full access to their health information. Many want to be able to see OpenNotes or clinic notes. Even more surprising was the number of mistakes people have discovered in their electronic health records.

Why Don’t People Read Their EHRs?

Most people never bother to access their electronic health records. That’s the conclusion of a study that analyzed data from over 2,000 U.S. hospitals (Health Affairs, online Nov. 4, 2019).  The authors reported that only 10 percent of patients accessed their electronic medical record:

“On average, hospitals gave 95 percent of discharged patients access to view, download, and transmit their information, but only about 10 percent of those with access used it… Overall, our findings suggest that policy efforts have failed to engage a large proportion of patients in the electronic use of their data…”

What is an EHR?

What is an electronic health record? According to the government, an EHR:

“is a digital version of a patient’s paper chart.”

Hospitals, clinics and doctors’ offices were encouraged to move to electronic formats. They were rewarded financially if they did so in a timely fashion.

The idea was to make information available instantly to patients and all the health professionals involved in their treatment. People were supposed to be able to see lab results, medical history, diagnoses, treatment plans, allergies and a record of all medications. Better informed patients were expected to become more engaged in their health. Of course the ultimate goal of electronic health records was improved health.

The Bean Counters Love EHRs

How well are electronic medical records working? One thing the EHR does really well is keep track of billing. Patients can see how much they owe and pay online when they access their medical record.

The EHR is often not as good at providing patients information about their diagnoses, treatment plans and something called “clinic notes”–the actual electronic health record that clinicians utilize.

Why Don’t Doctors Embrace OpenNotes?

There are a few exceptions. Some healthcare systems have adopted “OpenNotes,” which does permit patients to see what the healthcare providers are thinking. This transparency enhances communication.

In 2017, the people who came up with OpenNotes wrote that their use improves patient-doctor relationships (NEJM Catalyst, Oct. 12, 2017). The authors describe their OpenNotes system this way:

“The Power of the Written Word”:

“Every day, clinicians and patients have important conversations about health issues, but patients often forget what was said in the charged atmosphere of the office encounter. Among the patients in the OpenNotes trial who reviewed their notes, roughly 75% reported better recall of care plans, better self-care, a clearer understanding of their conditions, and feeling more in control of their health care.”

Patient Safety:

There is another key factor about providing patients access to the doctor’s clinic notes. The authors of the study report:

“Research shows that patients and their families can identify errors, including those not apparent to clinicians. In the OpenNotes trial, about one in three patients who reported contacting the doctor’s office did so to note a possible mistake.”

Expanding Electronic Health Records:

What do patients think about patient portals and OpenNotes? Our readers have offered their opinions.

William said:

“I look on my patient portal after every visit. It would be nice to see all notes.”

Mark also uses his patient portal:

“I keep up with mine, especially since I went on a plant-based diet. All of my blood work and health markers have improved.”

Patty remarked:

“I would love the OpenNotes system. Getting access to all of my surgical, nursing and clinic notes has been nearly impossible at a local hospital where I had two surgeries recently.”

Renee accesses her electronic health records but is disappointed that there isn’t much useful information:

“I always use the patient portal. None of the doctors allow the actual patient record – just ‘visit summaries.’ These are usually just a list of current meds and vital signs at the visit.

“The hospital will provide the full patient records for download but only upon special request to the medical records office and a different viewing process. It would be much simpler to just have full access automatically. More people would use it”

Not everyone is enthusiastic. Richard wrote:

“Waste of time for me. The available info is redundant and useless. Nothing of value at all.”

Cheryl said:

“I have and do read my records. Not only do I check what the doctor says, but I have also looked at my insurance and Medicare records. Truthfully, I feel helpless! I found so many mistakes. For example, in my insurance record, I found a dialysis treatment, which both Medicare and my insurance company reimbursed. I do not have kidney disease and have never had dialysis. I called Medicare twice and my insurance company three times to correct it. It is still showing in my record. Records are good only if they are correct!”

Mistakes in the Electronic Health Records:

Georgina corrected a mistake but it didn’t show up on the patient portal:

“I always check my father-in-law’s health record after he has a visit with a doctor. I help him with his medications, finances and records. I message his doctor with questions. (I am on his approved contact list.)

“Recently after a fall and surgery for a broken femur, I was checking his visit notes because I couldn’t be with him during his appointment. The clinic notes referenced the wrong femur that had been broken. He fractured the other femur last year, and the current notes copied those from a year ago.

“I messaged the doctor and requested a change. I then called when I noticed the changes had not been made after receiving an email stating they had. I was told that the corrections may not show on the portal but were corrected in the clinic notes.”

Carole was dismayed to discover so many errors:

“After a recent hospital stay, I decided to look at my records due to several medication mix-ups at the hospital. I was shocked to see how many errors were in my record. I spent a lot of time going thru everything and writing down things that needed to be changed or updated and then went to the site to correct things.

“I spent a long time trying to find a way to make the corrections, and there was no way to make changes. It was access-only. I will not bother to waste my time checking for errors in the future.”

Audrey shared similar frustration about her electronic health record:

“It’s not “My Chart,” it is “Your Chart.” I have no ability to correct information or change any errors. In theory, I can delete read messages. I delete them, and the next time I log in, they’re all back. In theory, I can correct the medication list, deleting medications I no longer use, and adding new ones. I have done this several times. The next time I log in, the changes are gone.

“Forget about changing incorrect clinician notes. I don’t know who this chart describes, but it is not me. It is a form of CYA for the medical profession.”

People’s Pharmacy Perspective:

We are great believers in access to health information. Patients have every right to see their clinic notes. Doctors make a surprising number of mistakes when it comes to diagnosis. If that seems hard to believe, please take a few minutes to listen to our interview with David Newman-Toker, MD, PhD. He is Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence. You will learn why you absolutely must take an active role in your health care.

The only way a patient can know what the doctor is thinking is to see what the doctor has written in the electronic health record. That way if there are errors the patient can try to correct them. Here is what OpenNotes says about its system:

Promote patient safety. Patients may notice errors in their notes. Correcting them helps make the record more accurate and can improve patient safety.”

Now that many patients have access to their electronic health records, it is time to take advantage of that access. Find out what is in your record, and then push for changes so that your information is both accurate and accessible. If your doctor, clinic or hospital does not offer OpenNotes or clinic notes, contact the people who manage the electronic health record and tell them that they are behind the curve. And if your health professional is not entering your clinic notes in the system, encourage her to do so.

Share your own thoughts about OpenNotes and electronic health records in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I use the portals if my doctors have them-I like having somewhere to help me remember when I went to the doc and to see test results. I am disappointed that more complete information is usually unavailable. And each has a separate system, so there is no one complete record, which would be so much more useful to both me and my doctors. I find massive duplication–you would think I was taking dozens of prescription medication because the short term treatment meds are not deleted or noted as short term (like antibiotics for UTI, pain meds for surgeries.) There could be much improvement in the use of computers and electronic medical records. I read once of doctors having an assistant that entered info as the doctors talked to the patient, so that the doc wasn’t staring at a computer the whole time.

Thank you for addressing this problem. Often important relevant information is missing from my office visit reords.

i too would use my so-called “patient portal” more if the information was correct … it often isn’t. and, like other commenters, trying to get the info changed is like pulling teeth with no result. i have found that the problem often lies with overworked nurses (which are often also the admin workers) … trying to update so many charts electronically. whatever regulations have been imposed on doctors have made the entire process less effective, in my view. our doctor/hospital system is a mess. definitely not user-friendly … if you do not have a trusted advocate, you easily could have a major mistake made when trying to get competent medical care.

Most of my doctors and healthcare are affiliated with the medical school of a state university. They have a “My Chart” that I access after every doctor visit or lab draw but this is pretty much what you stated in the article-vital signs, meds, diagnoses and other general information. I have never in the approximately 4 years My Chart has been available been able to access clinical notes even though I was told they would be available.

Through my last job prior to retirement I was able to access and print my records for a surgery I had in 2010 but there were no daily clinical notes available. Having worked in the medical profession for over 40 years, I can understand why you can’t make changes in the electronic record-if you made mistakes in what you entered, would the doctor or facility not be responsible for what’s in that record? I too would like to see my actual clinical notes but I don’t believe it will happen.

Please DO take the time to read the clinic notes you receive from your doctor’s office. I was preparing for surgery and met with a physician’s assistant for some history and preliminary testing. When I received the notes, I was truly alarmed. The report was at least 95% inaccurate with some very serious discrepancies, including a test I had not even been given and its results. These notes were being forwarded to my surgeon. I immediately sent back a response, addressing each point with the correct information. The PA called me and admitted she had accidently put another patient’s information into my record. If I had not taken the time to read these clinic notes, some harmful and potentially dangerous medical information would have reached my surgeon and could, possibly, have had an impact on my surgery.

I always check my online health record and I do find errors. In one, the doctor described me as obese. I am 5’3″ and weighed around 105 at the time. In order to get it corrected I had to: write to someone asking them to correct it, that had to be forwarded to the doctor to OK the correction, the doctor had to send written instructions to the administrator of the records to have them correct it. And to correct it they highlighted the word obese in red and put little black dashes through it. I just ignore the errors now, but do continue to read the record for my own amusement.

I was denied Long Term Insurance, because of my electronic “problem list.” I always check my chart, but had not noticed that every little issue or question mentioned to my Primary doctor was listed, even though they had been dismissed or ruled out. When my doctor realized this, she tried to correct the issue, but the insurance company did not reconsider.
No one should apply for insurance without a thorough review and correction of their chart.

Thank you for the explanation of my ongoing totally wrong electronic health records – no wonder so many ‘mistakes’ are made: from wrong diagnosis to wrong Rx, and each ‘care giver’ just following in the incorrect footsteps of the previous one; it’s a miracle when anyone survives the health care they receive!

As others have said, there are so many errors impossible to correct. It is frightening to consider the impact this misinformation has on our future health care and our finances!

I agree with the comments. I don’t bother reading my patient portal anymore as the information is old and useless

I use the portals for every provider who offers one. I think there’s only one that allows me to view (but saving them is a cumbersome process) clinical notes, there is none that offers the ability to correct errors, and they’re all riddled with errors.

I just returned from a week’s workup at a prestigious clinic. After a week or so, I got an e-mail saying my records were available, but the one provided was one of the most information-free documents ever. And it had errors in it. To get my REAL records, I had to download and print a 6-page form, fill it out by hand and sign it (one of my concerns is I can’t really use my hands any more), and mail or FAX it back to them. They promise the results in a few weeks.

This is obscene.

One of my pet peeves is that each doctor and hospital has their own unique system. It is frustrating to have to complete forms every time one goes to a new physician/specialist. If the system was uniform the records would be available to any physician/hospital once the patient gives their permission. In addition, there would only be one record to keep track of/audit. No doubt, whoever comes up with such a system will reap substantial financial rewards.

In my opinion, the definition in this article is hopeful but not accurate. An EHR is NOT “a digital version of a patient’s paper chart.” It is an electronic version which often leaves out pertinent information and is coded in a way that leaves the patient scratching their head. For instance, they use codes for procedures but do not give you the code breaker. And the incomplete and arcane nature of the EHR’s is exactly why so few patient’s bother with them.

ALL patients have the free right of access to their CORRECT medical records- doctor notes- etc. The system needs to be made more patient usage friendly so patients can use it better. Doctors do not like to do “paper work”,computer, their job is to DOCTOR. I have sat in my doctors ofc a good part of my ofc visits & watched in silence- as my doctor typed away at his computer with NO greeting or communication…I switched doctors!

Personally I think they are useless. Yes, they show vital signs. I already know mine. Yes, they show medications and they remain the same no matter what. It is a waste of paper when they give them to you at the doctors office.

My hospital and my providers don’t utilize “Open Notes” and it is almost impossible to get the records (lists of medications, summaries of procedures, etc) that are available corrected. It’s pretty much a waste and serves only to underscore the poor state of affairs of our bloated, overpriced, ineffective medical care systems. I have almost no faith in the health care systems available to me.

My recent record listed 5 items under “recommended” — this list started with the fascinating information that I should get my DPT shots in October 1945. A time machine would be necessary, but I vividly recall getting these at age 5 — my little brother had a huge tantrum in the doctor’s office and had to be held down to get his shot. I was stoic.

The following 4 ranged from 17 to 31 years ago (and yes, I had gotten all). When I asked my doctor’s assistant about this she said brightly, “Oh yes, that’s all that should have happened.” What a waste of time, and energy.

There should be one portal where you can see everything over the last 30 years. It’s like your credit report, there are usually errors possibly because of the constant info gathering that is conflicting or non-relevant or even inputted wrong. Everyone is trying to keep track of your every breath. Then again, having everything available online opens yourself up to hacking. And we have seen that companies handling sensitive info are extremely lax in providing protection from thieves.

This is the second time I’ve posted about the inaccuracies that occur. And how you can’t correct them. This week our insurance company copied us on a letter to our primary regarding blood stick tests we never had. Also, a fecal sample kit that was rejected for my husband even tho I was the person given the kit and test. I have no idea who to contact to correct all these errors. In addition, retired doctor who treated me for 18 years only had 5 years of my treatment digitized. This became critical when finding a new neurologist to work with. I advise everyone to keep a personal log of their medical info, visits, meds, studies, etc.

I really dislike EHR. I no longer use them—why? It was an exercise in frustration. There were so very many mistakes as described in the article. Just a few among many examples: Diagnosis and symptoms appeared that I never had in parts of my body that were healthy (so much so that I thought they mixed me up with another patient), misinterpretation of the history, as well as errors in dosages for supplements I take. Medicines I take PRN were listed as daily……I could go on and on. I would have to write the administrator of the EHR to correct the mistakes and it was an arduous process for it to go to the doc and then get fixed and there were times it NEVER got fixed.

I eventually gave up as it was just too frustrating for someone like me who feels details are important and can’t abide by information that isn’t correct on my record. Also I found it too time consuming to keep correcting it. So I no longer log in and with new doctors I refuse to set up a portal. Another thing, using the portal to ask about a problem was frustrating. The administrator would write back and not really answer the question so I would have to write back again, and we go on and on. Much better to call and talk to the nurse or medical assistant than this fraught with error way of communication. Basically dislike EHR and will NEVER use them again.

The reason so many errors in patients’ electronic records is that incompetent people are posting your medical info. Garbage in and garbage out. And good luck trying to correct it. Patient portals are an example of medical incompetence. If the people who pick up our trash were as careless as many medical people, we would have trash scattered all over our streets. They just don’t care!

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