EMR Interfaces Gone Wrong, Or The Tale Of The Albanian Patient

Today, for your consideration, we have the tale of the Albanian patient who wasn’t Albanian.  More broadly, I’m here to discuss the perils of adding an extra interface consideration to the workflow of busy EMR users, and the impact that has on data quality.

Scope, a blog published by the Stanford School of Medicine, shares the case of the Merced County, California physician who, exasperated with the requirement that he identify the ethnicity of each patient, chooses “Albanian” for all of them. Why? Simply because “Albanian” is the first item of the rather long list in the pulldown menu.

As a result of this interface issue, any attempt to mine this veteran doctor’s data for population health analysis is weakened, writes Anna Lembke, MD, asssistant professor of psychiatry and behavioral sciences at Stanford.  And this physician’s choices should give the “big data” users pause, she suggests:

Misinformation in electronic medical records, whether accidental or otherwise, has far-reaching consequences for patients and health care policy, because electronic medical records are being actively ‘data-mined’ by large health care conglomerates and the government as a basis for improving care. This is an important downside to consider as we move forward.

Dr. Lembke’s observations are important ones. If government entities and health organizations would like to mine the increasingly large pools of data EMRs are collecting, it’s important to look at whether the data collected actually reflects the care being given and the patients being seen.

I’m not suggesting that we audit clinicians’ efforts wholesale — they’d rightfully find it offensively intrusive — but I am suggesting that we audit the interfaces themselves from time to time.  Even a quarterly review of the interfaces and workflow an EMR demands, and results it produces, might help make sure that the data actually reflects reality.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • This is a systems issue.

    Why should the Doc be wasting his time entering ethnicity?

    That should be entered by the scheduler or the medical assistant

    We have moved work that used to be done by ancillary personnel onto the Doc. Increasing the workload of the highest paid individual who is also the person responsible for generating income, while decreasing the workload of low cost employees is the height of stupidity.

    We need more patient data entry, more data entry by staff, more clinical decision support. The Doc should be working less and doing more and producing more high quality outcomes with the use of good HIT. Unfortunately, the EHR does none of this.

  • I would say that data mining is not used for improving care; it is used to decide what zip code gets the most federal funds/grants due to their “diversity” in race, namely foreigners. White Americans need not apply.

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