Electronic health records are dangerously inaccurate.

Most people believe that their medical chart is accurate, that their doctors and nurses are smart and won’t put the wrong information in their chart. They are wrong.

A few weeks ago, I was writing a progress note in our computerized record when I noticed that there was a strange illness in the patient’s history: “Walking-corpse syndrome”. I had never heard of it, but it seemed quite unpleasant. It was in the main patient problem list, along with diabetes, hypertension, glaucoma, and other medical problems, populated by the computer into almost every doctor’s progress note. I didn’t know how to remove it from the main problem list. I still don’t.

“Walking corpse syndrome” is an extremely rare delusion in which a physically healthy patient believes that they are dead. I knew this was a mistake. I just couldn’t figure out how someone accidentally wrote this in the chart — until I saw the entry screen for that problem list. “Walking corpse syndrome” was the first item on the list because it was written with the quotation marks, which came before “A” in the program’s alphabet. Someone had simply clicked on it accidentally, and now it’s stuck in this patient’s record forever. Pretty insulting, if you ask me.

But no one asked me. And no one is going to. I don’t blame the software engineers who build electronic health records, because mistakes happen all the time when designing user interfaces, and they have no access to real world clinician feedback because of patient privacy limitations. Popular apps like Instagram and Facebook learn how to make their apps better by listening to the people who use them. But electronic health record (EHR) programs aren’t able to do that. They aren’t exactly eager, either. Their customers are hospitals and giant practices, not clinicians like me. The hospital CEO and executives decide on which EHR to use, and those decisions are usually financially based. Most EHRs are excellent at medical billing, but fall short as a medical record.

I’ve seen some strange errors in the chart that were obvious mistakes, like a CT scan that read “normal prostate” in a female patient. But others might go unnoticed, like the wrong resuscitation code status. That’s important if you don’t want a suffering patient to receive painful electric shocks when they die. Sometimes the errors are an affront to the patient’s dignity, like a patient whose chart said he had syphilis (he didn’t). I recently saw a patient whose chart said she had cerebral palsy, a congenital muscle disease. That wasn’t correct — she had suffered a spinal injury in her 60s, which is a completely different problem. Unfortunately, the cerebral palsy diagnosis was plastered all over the chart, just like the walking corpse disease.

So don’t be a walking corpse; be skeptical about what’s in your medical record. Better yet, keep track of your own health. I’m not trying to scare anyone, so I’ll leave you with this list of sentences exactly as typed by medical secretaries in NHS registers, Greater Glasgow:

1. The patient has no previous history of suicide.
2. Patient has left her white blood cells at another hospital.
3. Patient’s medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status: Alive, but without my permission.
10. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in ER, she was examined, x-rated and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life until she got a divorce.
19. I saw your patient today, who is still under our care for physical therapy.
20. Both breasts are equal and reactive to light and accommodation.
21. Examination of genitalia reveals that he is circus sized.
22. The lab test indicated abnormal lover function.
23. Skin: somewhat pale, but present.
24. The pelvic exam will be done later on the floor.
25. Large brown stool ambulating in the hall.
26. Patient has two teenage children, but no other abnormalities.
27. When she fainted, her eyes rolled around the room.
28. The patient was in his usual state of good health until his aeroplane ran out of fuel and crashed.
29. Between you and me, we ought to be able to get this lady pregnant.
30. She slipped on the ice and apparently her legs went in separate directions in early December.