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\title{Data and Edits in Healthcare Information Management}
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\begin{document}

             \author[1]{Sajeesh  Kumar}

             \affil[1]{  University of Tennessee Health Science Center}

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\date{\small \em Received: 11 February 2015 Accepted: 28 February 2015 Published: 15 March 2015}

\maketitle


\begin{abstract}
        


This studydetermine which job function causes or creates a large number of Edit/ Data Overwrites within health care. The study is based on data extracted from the Monthly Reports reported by the Team staff. Out of the 2736 Potential Identity Changes, 115 actually resulted in a CE. The number of CEs created by each job title ranged from 1% by Employee Health Clerk to 28% by Eligibility Clerk. Out of the 115 CEs created, a total of 32 were created by the Eligibility Clerks. The next highest job title was the Enrollment/Registration Clerks with 21 CEs created. Of the 4% of CEs reported, Eligibility Clerks created 28% of those CEs and Enrollment/Registration Clerks created 18% of CEs reported during this time period. The findings provide insight to thestaff as well as other managers for the users who need additional training or realignment in the workflow. Further work is required to expand and identify factors contributing to incidents causing CEs.

\end{abstract}


\keywords{data; edits, health informatics.}

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\let\tabcellsep& 	 	 		 
\section[{I.}]{I.}\par
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.\par
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.\par
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. 
\section[{Background}]{Background}\par
There are several studies and researches conducted that focuses on the patient safety incident involving human computer related incidents.  {\ref 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).\par
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 \hyperref[b1]{(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. 
\section[{III.}]{III.} 
\section[{Methods}]{Methods}\par
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.\par
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.\par
IV.  
\section[{Results}]{Results} 
\section[{From}]{From}( D D D D ) K V. 
\section[{Discussion}]{Discussion}\par
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.\par
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. 
\section[{VI.}]{VI.} 
\section[{Conclusion}]{Conclusion}\par
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).\par
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.  
\section[{Volume XV}]{Volume XV}\begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.038636363636363635\textwidth}P{0.47909090909090907\textwidth}P{0.3322727272727273\textwidth}}
\tabcellsep Total\tabcellsep \\
\tabcellsep Potential\tabcellsep Total\\
\tabcellsep ID\tabcellsep Catastrophic\\
\tabcellsep Changes\tabcellsep Edits\\
\tabcellsep 80\tabcellsep 10\\
\tabcellsep 87\tabcellsep 8\\
\tabcellsep 90\tabcellsep 9\\
\tabcellsep 82\tabcellsep 8\\
\tabcellsep 92\tabcellsep 4\\
\tabcellsep 103\tabcellsep 12\\
\tabcellsep 100\tabcellsep 6\\
\tabcellsep 359\tabcellsep 8\\
\tabcellsep 344\tabcellsep 13\\
\tabcellsep 352\tabcellsep 8\\
\tabcellsep 715\tabcellsep 4\\
\tabcellsep 158\tabcellsep 5\\
\tabcellsep 79\tabcellsep 17\\
\tabcellsep 95\tabcellsep 3\\
Total\tabcellsep 2736\tabcellsep 115\end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.6456973293768546\textwidth}P{0.07062314540059347\textwidth}P{0.13367952522255191\textwidth}}
Year 2015\tabcellsep \tabcellsep \\
Volume XV Issue 2 Version I\tabcellsep \tabcellsep \\
\tabcellsep CEs\tabcellsep \% of CEs\\
TITLE OF CE ORIGINATOR\tabcellsep Created\tabcellsep Created\\
Admin Officer of the Day (AOD)\tabcellsep 2\tabcellsep 2\%\\
Clinic Clerk\tabcellsep 8\tabcellsep 7\%\\
Clinical (Medical/Surgical) Staff\tabcellsep 4\tabcellsep 3\%\\
Eligibility Clerk\tabcellsep 32\tabcellsep 28\%\\
Employee Health Clerk\tabcellsep 1\tabcellsep 1\%\\
Enrollment/Registration Clerk\tabcellsep 21\tabcellsep 18\%\\
Health Staff\tabcellsep 6\tabcellsep 5\%\\
MPI\tabcellsep 15\tabcellsep 13\%\\
Other\tabcellsep 16\tabcellsep 14\%\\
Supervisor\tabcellsep 7\tabcellsep 6\%\\
Regional Office Staff\tabcellsep 3\tabcellsep 3\%\\
Total\tabcellsep 115\tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.013027838598686269\textwidth}P{0.05477009696590553\textwidth}P{0.23396934626212074\textwidth}P{0.5288238974038161\textwidth}P{0.01940882076947138\textwidth}}
\tabcellsep A C\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep A C\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep A D\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep D G\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep F G\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep F J\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep G K\tabcellsep Manual Catastrophic Merge\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep G K\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep G P\tabcellsep Manual Catastrophic Merge\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep G R\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep H R\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep H T\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
\tabcellsep I T\tabcellsep Manual Manual\tabcellsep Eligibility Clerk MPI POC\tabcellsep \\
Year 2015\tabcellsep I I K T W A\tabcellsep Manual Manual/Mismatch Manual Manual Manual Manual\tabcellsep Eligibility Clerk Eligibility Clerk Eligibility Clerk MPI POC MPI POC Other *\tabcellsep Year 2015 Year 2015\\
\tabcellsep P D\tabcellsep Manual Manual\tabcellsep Eligibility Clerk Other *\tabcellsep \\
\tabcellsep P G\tabcellsep Manual Mismatch/Auto-Link\tabcellsep Eligibility Clerk Other *\tabcellsep \\
Volume XV Issue 2 Version I\tabcellsep P 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 A\tabcellsep Manual 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 Manual\tabcellsep Eligibility 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 * Supervisor\tabcellsep Volume XV Issue 2 Version I\\
( D D D D ) K\tabcellsep C C G K\tabcellsep Manual Manual Manual Manual/Catastrophic Merge\tabcellsep Enrollment/Registration Clerk Enrollment/Registration Clerk Supervisor Supervisor\tabcellsep ( D D D D ) K ( D D D D ) K\\
\tabcellsep D T\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Supervisor\tabcellsep \\
\tabcellsep D U\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Supervisor\tabcellsep \\
\tabcellsep F W\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Supervisor\tabcellsep \\
\tabcellsep F W\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Supervisor\tabcellsep \\
\tabcellsep G J\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Regional Office Staff\tabcellsep \\
\tabcellsep H T\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Regional Office Staff\tabcellsep \\
\tabcellsep H W\tabcellsep Manual Manual\tabcellsep Enrollment/Registration Clerk Regional Office Staff\tabcellsep \\
\tabcellsep H\tabcellsep Manual\tabcellsep Enrollment/Registration Clerk\tabcellsep \\
\tabcellsep H\tabcellsep HOW CE OCCURRED Manual\tabcellsep Enrollment/Registration Clerk\tabcellsep \\
\tabcellsep VISN H\tabcellsep (Manual, etc.) Upload\tabcellsep TITLE OF CE ORIGINATOR Enrollment/Registration Clerk\tabcellsep \\
\tabcellsep F 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 G\tabcellsep 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 Manual Manual\tabcellsep Enrollment/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\tabcellsep \end{longtable} \par
  {\small\itshape [Note: © 2015 Global Journals Inc. (US)]} 
\caption{\label{tab_4}}\end{figure}
 			\footnote{© 2015 Global Journals Inc. (US)} 		 		\backmatter  			 			 			  				\begin{bibitemlist}{1}
\bibitem[Magrabi et al. ()]{b4}\label{b4} 	 		‘An analysis of computer related patient safety incidents to inform the development of a classification’.  		 			F Magrabi 		,  		 			M Ong 		,  		 			W Runciman 		,  		 			E Coiera 		.  		 doi:10.1136/ jamia.2009.002444.  	 	 		\textit{Journal of the American Medical Informatics Association}  		2010. 17 p. .  	 
\bibitem[Data Entry Requirement for Administration Data. VHA Directive 2009-021 ()]{b3}\label{b3} 	 		\textit{Data Entry Requirement for Administration Data. VHA Directive 2009-021},  		 \url{http://www.va.gov/vhapublications/ViewPublication.asp?pub\textunderscore ID=2012}  		2009.  	 
\bibitem[Repair of Catastrophic Edits to Patient Identity. Veteran Health Administration (VHA) Handbook 1907.05 ()]{b2}\label{b2} 	 		\textit{Repair of Catastrophic Edits to Patient Identity. Veteran Health Administration (VHA) Handbook 1907.05},  		 \url{http://www1.va.gov/vhapublications/ViewPub-lication.asp?pub\textunderscore ID=2053}  		2009.  	 
\bibitem[Ash et al. ()]{b1}\label{b1} 	 		‘Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors’.  		 			J Ash 		,  		 			M Berg 		,  		 			E Coiera 		.  		 \xref{http://dx.doi.org/10.1197/jamia.M1471}{10.1197/jamia.M1471}.  	 	 		\textit{Journal of the American Medical Informatics Association}  		2003. 11  (2) .  	 
\bibitem[Table 1: Edits Reports]{b5}\label{b5} 	 		\textit{Table 1: Edits Reports},  		 	 
\bibitem[Adelman et al. ()]{b0}\label{b0} 	 		‘Understanding and preventing wrong patient electronic orders: a randomized controlled trail’.  		 			J Adelman 		,  		 			G Kalkut 		,  		 			C B Schechter 		,  		 			J M Weiss 		,  		 			M A Berger 		,  		 			S H Reiddman 		,  		 			W N Southern 		.  	 	 		\textit{Journal of the American Medical Informatics Association}  		2012. 10 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
