321 - Identifying Incorrect Contact Information in Pediatric Records

Publication Number: 1305.321

Jonathan Hatoun, Pediatric Physicians' Organization at Children's, Boston, MA, United States; Eleanor Verhagen, Boston Children's Hospital, Boston, MA, United States; Nymisha Chilukuri, Stanford University School of Medicine, San Francisco, CA, United States; Naveed Rabbani, Harvard Medical School, Boston, MA, United States; Natalie M. Pageler, Stanford University School of Medicine, Sunnyvale, CA, United States

Background: Accurate contact information is an important part of providing timely, safe, patient-centered care, particularly to adolescent patients for whom confidential conversations are needed. Electronic Health Records (EHRs) allow for entry of both patient and guardian contact information in discrete areas. In pediatrics, frequently a guardian's information is entered as the patient's contact information. As young patients age, the persistence of guardian information in patient fields can lead to breaches in confidentiality.

Objective: To quantify the accuracy of pediatric patient contact information in the EHR.

Design/Methods: We examined active patients in a state-wide primary care network in MA that uses the Epic EHR. Using the principle that contact information should only be entered into the patient record in fields attributed to the person who will respond, we devised a set of rules to determine when improper entry of information was occurring. The rules differed by age, given no child < 13 yrs would be expected to have a phone or email address, that some children 13 yrs and older may have an independent phone and private medical concerns, and that most adults 18 years old and above should be contacted directly. Similar rules were created for email addresses. We assessed patient information at the network level and for each practice to understand performance and variability.

Results: We analyzed the contact information of 440,393 active patient charts (257,630 were < 13yrs, 102,461 were 13-17 yrs, and 80,302 were 18+yrs). The population was 51.0% male, 68.3% non-Hispanic, 62.1% white, 95.0% English speaking, and 88.5% had an activated portal account. Improper phone data was found mostly in children and adolescents (99.9% of charts < 13 yrs, 93.6% of 13-17 yrs, and 64.2% of 18+ yrs). Improper email data was found less frequently in each age group, but similarly more so in children and adolescents (20.2% of < 13 yrs, 31.7% of 12-17 yrs, and 1.0% of 18+ yrs). Histograms demonstrating the variability of proper contact entry by the practices in the network for both phone numbers and email can be seen by age in Figure 1.

Conclusion(s): There is widespread entry of guardian contact information into the EHR fields meant for patient information, increasing the likelihood of a confidentiality breach as patients age. Certain clinical teams utilize appropriate fields more routinely, but without systematic changes to the entry fields of EHR's to discourage the entry of inappropriate data - such as disallowing phone entry to children below 13 yrs - communication errors and confidentiality breaches will continue to be made.

Figure 1
Boxplots demonstrating the variability of proper contact entry by phone and email by age group. Each contributing data point represents the proportion of patients with inappropriate contact information at a single practice in the network.