Healthcare providers were either randomly restricted to only one open patient record at a time or unrestricted to up to four patient records open concurrently.

Jason Adelman Addresses Important Question in JAMA: Does Allowing Multiple Records Open in an EHR Put Patients at Risk?

May 15, 2019

Dr. Jason Adelman, Assistant Professor of Medicine and Executive Director of the Patient Safety Research Program, has published a randomized trial in JAMA, addressing an important question: Does restricting providers to one patient record open at a time, instead of allowing multiple open patient records concurrently, reduce wrong-patient errors?

The study, led by researchers here at Columbia University Irving Medical Center (CUIMC), was set in a large academic health system and included 3,356 ordering providers. Half of the providers were randomly assigned to a restricted arm and could open only one patient record at a time. The other half was randomized to an unrestricted arm in which they could open up to four patient records at once. Dr. Adelman and colleagues compared the rate of wrong-patient order sessions, i.e. a series of orders by a clinician for a single patient, that included an order placed for the wrong patient. These wrong-patient orders were identified using the Wrong-Patient Retract-and-Reorder measure, an electronic algorithm which he developed. With approximately 4.5 million for more than 500,000 patients over 19 months, the study found no significant difference in the rate of wrong-patient order sessions between the restricted and unrestricted groups, overall or in any clinical setting.

Providers were randomly assigned to open 1 patient record (Restricted arm) or up to 4 records (Unrestricted arm) at a time.

In an accompanying editorial, Dr. Robert Wachter, Chair of the Department of Medicine at the University of California, San Francisco, commends the study as "the first to use this kind of approach [leveraging user data to adapt EHR systems] in addressing an important question." He added later that the study results are reassuring — that allowing providers to open multiple patient records at once is a reasonable approach.

Dr. Adelman is looking forward to next steps. In an interview for CUIMC, he stated, "For our next study, we will look at provider satisfaction—whether the technology helps providers do their jobs effectively—in the two groups from our randomized trial." With further research, Dr. Adelman and the Patient Safety Research Program hopes to provide further insight and to continue balancing provider support with patient safety.