Patient-initiated electronic health record amendment requests

Abstract

Background and objective: Providing patients access to their medical records offers many potential benefits including identification and correction of errors. The process by which patients ask for changes to be made to their records is called an 'amendment request'. Little is known about the nature of such amendment requests and whether they result in modifications to the chart.

Methods: We conducted a qualitative content analysis of all patient-initiated amendment requests that our institution received over a 7-year period. Recurring themes were identified along three analytic dimensions: (1) clinical/documentation area, (2) patient motivation for making the request, and (3) outcome of the request.

Results: The dataset consisted of 818 distinct requests submitted by 181 patients. The majority of these requests (n=636, 77.8%) were made to rectify incorrect information and 49.7% of all requests were ultimately approved. In 6.6% of the requests, patients wanted valid information removed from their record, 27.8% of which were approved. Among all of the patients requesting a copy of their chart, only a very small percentage (approximately 0.2%) submitted an amendment request.

Conclusions: The low number of amendment requests may be due to inadequate awareness by patients about how to make changes to their records. To make this approach effective, it will be important to inform patients of their right to view and amend records and about the process for doing so. Increasing patient access to medical records could encourage patient participation in improving the accuracy of medical records; however, caution should be used.

Figure 1

A timeline of significant events at our health system that influenced the study analyses.

Figure 2

(A) Number of charts requested per quarter by patients/families or for legal/subpoena reasons. Data prior to July 2010 are imputed as earlier logs did not distinguish chart requests made for direct clinician-to-clinician transfer from those made by patients/families or for legal/subpoena reasons. (B) Number of amendment requests per quarter. The column marked with an asterisk (*) shows an increase in request volume that coincided with the introduction of the patient portal and after-visit summary (AVS) around that time. Note that not all processed requests were archived until July 2008.

Figure 3

Age distribution of the 181 patients for whom an amendment request was made. For comparison, the overall age distribution of patients in our health system is also shown.

Figure 4

The approval rates for each of the sub-categories for clinical/documentation area (columns) broken down by the three categories for patient motivation for making the request (rows). The bottom row shows the overall number of approved requests for each clinical/documentation area, whereas the rightmost column shows the overall number of approved requests for each category of patient motivation for making the request. Each cell has been shaded to show the range of approval rates.