Displaying Patient Photos in Medical Records Reduces Errors, Improves Patient Safety

Wrong patient orders can harm patients

While digital solutions like computerized provider order entry (CPOE) systems have reduced medical errors and improved patient safety, the risk of placing orders for the wrong patient still exists. Wrong patient orders can relate to medications, lab and imaging tests, procedures, nursing orders, consults, discharges, and other orders.

“Orders placed on the wrong patient should be a ‘never event,’ as in it should never happen,” said Dr. Jason Adelman, a practicing clinician and leading patient safety expert at Columbia University. Displaying photographs of the patient in the electronic health record (EHR) could potentially reduce wrong patient errors. “Our brains process images quicker and more effortlessly than words, making it much easier for a clinician to know if they are in the wrong record when they see a photo,” says Dr. Adelman.

Displaying photos in the EHR

Dr. Adelman led a study to see whether displaying patient photos—and how they were presented—in EHRs prevented orders on the wrong patients. The team wanted to assess the effect of displaying patient photos in a passive way, using a photo in a banner, called “Storyboard” in Epic, where there is no specific action a provider needs to take. This compares to photos presented in an interruptive popup, where a patient photo is displayed in an ID verification alert, and providers must click to verify they are in the correct patient’s chart. The researchers tested three interventions versus a no-photo group: 1) Storyboard with photo, 2) the popup alert with photo, and 3) both Storyboard with photo and popup alert with photo.

Wrong patient orders were identified by using the Wrong-Patient Retract-and-Reorder Measure (WP-RAR), a validated, reliable, and automated method for identifying wrong-patient orders developed by Dr. Adelman. The WP-RAR measure identifies orders placed for a patient and retracted within 10 minutes, then reordered by the same clinician for a different patient within the next 10 minutes. These are called near-miss errors, which are self-caught by the clinician before they reach the patient and potentially cause harm.

A key piece to making the photo verification work? The availability of patient photos in the EHR. At the start of the study, only about 40 percent of patients had photos available. Over 3 months, the research team worked with patient services, information services, and operations to increase the number of patient photos. This included developing a job aid, training staff on how and when to take photos, and activating settings on kiosks to enable patients to take their own photo during registration.

“We need rigorous evidence to demonstrate a safety practice, which can motivate hospitals to adopt these practices. We hope this research can help accelerate the adoption of photos in EHRs.” – Dr. Jason Adelman

Photos improve patient safety

The research demonstrated that all three combinations of photo display significantly reduced orders on the wrong patients compared with no photos displayed. Notably, there were no significant differences between the two different photo displays, Storyboard versus popup; both showed improved action by the provider. Displaying the patient’s photo in a noninterruptive banner in the EHR worked as well as the popup alert. The findings are significant, according to Dr. Adelman: “Photos in Storyboard passively work so well that adding a pop-up has a small increase, but not statistically significant and likely not worth the burden to alert fatigue.” Given the burden of alert fatigue on clinicians, he advocates the use of passive intervention to maximize benefit and minimize burden on clinicians.

Findings from the study support the widespread implementation of patient photos by health systems and the continued development and expansion of features to display patient photos by EHR vendors. To support uptake of photo use, Dr. Adelman and his team are developing a toolkit that summarizes their experience and includes synthesized materials developed during implementation. The kit will include various methods on how to incorporate patient photos in different technical environments. An addendum provides specifications on how to capture a quality patient photo, checklists and templates, sample policies and workflows, and training and patient education materials.