From the Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality; and Johns Hopkins University, School of Medicine, and Health Information Technology, Baltimore, Maryland.
J Patient Saf. 2021 Oct 1;17(7):e665-e671. doi: 10.1097/PTS.0000000000000434.
Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training.
We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months.
The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years.
Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.
重复创建医疗记录是一种常见且后果严重的医疗系统错误，通常是由于搜索系统可用性差和用户培训不当造成的。
我们对处于产生重复医疗记录风险中的患者登记员进行了两个阶段的基于场景的可用性测试。第一阶段评估了现有的搜索系统，这导致了系统重新设计。第二阶段测试了重新设计的系统，以在系统全面实施前减轻潜在错误。为了评估系统的有效性，我们比较了实施前和实施后每月潜在重复医疗记录的比率。
现有的系统无法有效地处理拼写错误，导致搜索失败和重复创建医疗记录。使用现有的系统，96%的登记员找到了常见的拼写患者姓名，而只有 69%的人成功找到了复杂的姓名。登记员缺乏知识和使用音标匹配功能来帮助处理拼写错误。新系统无论拼写错误与否都能始终正确捕获患者，但搜索返回的潜在匹配更多，导致选择常见姓名的时间平均增加了 4 秒。实施新系统后，潜在的每月重复医疗记录率从 4%降至 2.3%，并在两年内平均保持在 2.5%。
可用性测试是一种有效的方法，可以揭示问题并帮助系统重新设计，以提供更用户友好的系统，从而降低医疗记录重复的可能性。更高的可用性标准将确保在患者面临风险之前而不是之后实现这些改进。
