# I. Data and Edits in Healthcare Information Management here has been a significant increase in the number of occurrences of catastrophic edits to patient identity traits. Catastrophic Edit (CE) are changes to a patient's electronic health record that result in the record being changed to that of another patient, caused by, but not limited to, edits to patient identity data (such as name, Social Security Number (SSN), date of birth, gender) and/or erroneous merging of two or more distinct patient records into a single record. While monitoring the changes, it has beendiscovered a recurring issue of catastrophic edits to patient identity traits. These edits are often a result of an inappropriately editing of an existing record through mis-selection or error. These errors can affect administrative, clinical, and billing processes as well as affect patient care causing a significant patient safety risk. The purpose of this study is to investigate the role (job title) of the originator of the Catastrophic Edits/Data Overwritesto identify the correlation between the role and the number of Catastrophic Edits. The objective of this study is to determine which job function causes or creates a large number of Catastrophic Edits/ Data Overwrites. # Background There are several studies and researches conducted that focuses on the patient safety incident involving human computer related incidents. Magrabi Of the 123 incidents retrieved, four duplicates and eight incidents that did not relate to patient safety were removed, leaving 111 incidents. Of the 111 incidents, eight were described as an improvement in patient safety due to Information Technology (IT) and four were unresolvable, leaving 99 incidents. Information input issues accounted for the largest category with 31% of the incidents. These issues included were related incorrect human data entry such as incorrect selection of patient and typographical errors. Information output data accounted for 20% of incidents, which included problems with human-computer interaction such as error in interpreting, printed information due to poor quality or data retrieval errors (Magrabi, Ong, Runciman, & Coiera, 2010). Ash, Berg and Coiera (2003) discussed errors in the process of entering and retrieving information in or from the system based on ethnographic observations and semi-structured interviews with healthcare professionals. They discussed in detail the problem of a human-computer interface that is not suitable for a highly interruptive use context. By health care professional often being interrupted by patients, telephones and other colleagues, the mismatch between interface and use context often resulted in a juxtaposition error. A juxtaposition error is an error caused when something is close to something else on the screen and the wrong option is too easily clicked in error (Ash, Berg and Coiera, 2003). The authors found there were instances of patient confusion when orders were entered for the wrong patient. They also found that overly structure data entry led to a loss of cognitive focus. The use of many screens or need to switch between screens results in error. # III. # Methods This study examined Catastrophic Edits (CEs) reported by team staff between November 2011 through December 2012. Due to privacy and security policies, the sites and CEs have been de-identified. The role or functional job title of the medical center staff who createdthe CE options consists of the following job titles: Administrator of the Day (AOD), Clinic Clerk, Clinical (Medical/Surgical) Staff, Eligibility Clerk, Employee Health Clerk, Enrollment/ Registration Clerk, Health Eligibility Center (HEC) Staff, Point of Contact (POC), Personnel/Human Resources (HR) Clerk, Privacy Officer, Supervisors, Ward Clerk and Other. The options for how the CE occurred include: Manual, Primary View Updates, Catastrophic Merge, Upload, and unknown, Mismatch/Auto Link. The data collected from the Monthly CE Reports was compiled using Microsoft Excel. The data was extracted and entered in separate MS Excel worksheets. The data extracted was entered in MS Excel worksheets and categorized by titles of the originator, sites, and how the CE occurred. The number of CEs created and the job title of the creator of the CE were calculated and a bar graph was formulated to identify the actual number of CEs created by each job title. The number of CEs were calculated and a bar graph was formulated to identify the number of CEs. The number potential CEs calculated against the number of actual CEs each month was charted and a bar graph was formulated to compare the potential CEs vs. the actual CEs. IV. # Results # From ( D D D D ) K V. # Discussion In this study various tools were used to examine the role or functional job title of the medical center staff that created the CE on the MPI. The findings reveal that out of the number Potential Identity Changes, 4% actually resulted in a CE, which is considered relatively high compared to the medical staff's goal of creating less than 1% of CEs. This study found that the job titles with the highest occurrence of CEs are Eligibility Clerks and Enrollment/Registration Clerks. There wereseveral limitations to this study.These finding may be less applicable to other health care institutions or users that edits data within records. Another limitation was in cases where the job title of the CE was undetermined or unknown, the CE was documented and counted in the "Other" section for this study. This may have caused underrepresentation of the job title of the user who created the CE.Lastly, the Catastrophic Edit report used to examine the CEs that have occurred may contain errors or inaccuracies in documentation. # VI. # Conclusion Of the 4% of CEs reported, Eligibility Clerks created 28% of those CEs and Enrollment/Registration Clerks created 18% of CEsreported during this time period. Eligibility Clerks and Enrollment/Registration clerks work in a high traffic multifunctional work environment that results in errors caused by misclicking, interruptions, entering and retrieval of wrong patient. According to Magrabi, Ong, Runciman & Coiera, most information input problems were associated incorrect data entry such as incorrect selection of the patient name, data entry in incorrect fields and typographical errors. Factors reported included lack of training, failure to carry out a duty, high cognitive workload and effects of multitasking (2010). The findings of this study produced useful information about the users to which yieldsto further research with identifying various causes of CEs.Since this study did not evaluate the actual causes of the CEs, further work is required to expand and identify factors contributing to incidents causing CEs. # Volume XV 2TotalPotentialTotalIDCatastrophicChangesEdits80108789098289241031210063598344133528715415857917953Total2736115 3Year 2015Volume XV Issue 2 Version ICEs% of CEsTITLE OF CE ORIGINATORCreatedCreatedAdmin Officer of the Day (AOD)22%Clinic Clerk87%Clinical (Medical/Surgical) Staff43%Eligibility Clerk3228%Employee Health Clerk11%Enrollment/Registration Clerk2118%Health Staff65%MPI1513%Other1614%Supervisor76%Regional Office Staff33%Total115 A CManual ManualEligibility Clerk MPI POCA CManual ManualEligibility Clerk MPI POCA DManual ManualEligibility Clerk MPI POCD GManual ManualEligibility Clerk MPI POCF GManual ManualEligibility Clerk MPI POCF JManual ManualEligibility Clerk MPI POCG KManual Catastrophic MergeEligibility Clerk MPI POCG KManual ManualEligibility Clerk MPI POCG PManual Catastrophic MergeEligibility Clerk MPI POCG RManual ManualEligibility Clerk MPI POCH RManual ManualEligibility Clerk MPI POCH TManual ManualEligibility Clerk MPI POCI TManual ManualEligibility Clerk MPI POCYear 2015I I K T W AManual Manual/Mismatch Manual Manual Manual ManualEligibility Clerk Eligibility Clerk Eligibility Clerk MPI POC MPI POC Other *Year 2015 Year 2015P DManual ManualEligibility Clerk Other *P GManual Mismatch/Auto-LinkEligibility Clerk Other *Volume XV Issue 2 Version IP I P Q Q R R R S T T T U V T P P P P P P P P P P P U AManual Manual Manual Manual Manual Manual Manual/Mismatch Manual Manual Manual Manual Manual Manual Manual Manual Manual Upload Upload Upload Upload Upload Upload Upload Upload Upload Upload Manual ManualEligibility Clerk Other * Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Eligibility Clerk Employee Health Clerk Other * Other * Other * Other * Other * Other * Other * Other * Other * Other * Other * Other * SupervisorVolume XV Issue 2 Version I( D D D D ) KC C G KManual Manual Manual Manual/Catastrophic MergeEnrollment/Registration Clerk Enrollment/Registration Clerk Supervisor Supervisor( D D D D ) K ( D D D D ) KD TManual ManualEnrollment/Registration Clerk SupervisorD UManual ManualEnrollment/Registration Clerk SupervisorF WManual ManualEnrollment/Registration Clerk SupervisorF WManual ManualEnrollment/Registration Clerk SupervisorG JManual ManualEnrollment/Registration Clerk Regional Office StaffH TManual ManualEnrollment/Registration Clerk Regional Office StaffH WManual ManualEnrollment/Registration Clerk Regional Office StaffHManualEnrollment/Registration ClerkHHOW CE OCCURRED ManualEnrollment/Registration ClerkVISN H(Manual, etc.) UploadTITLE OF CE ORIGINATOR Enrollment/Registration ClerkF I F J H L H O I P J T J U L W L R U G G G K G U G V G A GManual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual Manual ManualEnrollment/Registration Clerk Admin Officer of the Day (AOD) Enrollment/Registration Clerk Admin Officer of the Day (AOD) Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk Clinic Clerk Enrollment/Registration Clerk (DoD) Clinic Clerk HEC Staff Clinic Clerk HEC Staff Clinical (Medical/Surgical) Staff * HEC Staff Clinical (Medical/Surgical) Staff * HEC Staff Clinical (Medical/Surgical) Staff * HEC Staff Clinical (Medical/Surgical) Staff * Eligibility Clerk HEC Staff© 2015 Global Journals Inc. (US) © 2015 Global Journals Inc. (US) * Understanding and preventing wrong patient electronic orders: a randomized controlled trail JAdelman GKalkut CBSchechter JMWeiss MABerger SHReiddman WNSouthern Journal of the American Medical Informatics Association 10 2012 * Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors JAsh MBerg ECoiera 10.1197/jamia.M1471 Journal of the American Medical Informatics Association 11 2 2003 * Repair of Catastrophic Edits to Patient Identity. Veteran Health Administration (VHA) Handbook 1907.05 2009 * Data Entry Requirement for Administration Data. VHA Directive 2009-021 2009 * An analysis of computer related patient safety incidents to inform the development of a classification FMagrabi MOng WRunciman ECoiera doi:10.1136/ jamia.2009.002444 Journal of the American Medical Informatics Association 17 2010 * Table 1: Edits Reports