The Role of Framing and Choice Architecture in Patients' Reactions and EHR Error Discovery and Reporting

The University of Texas System (UT)

Status: Invitation-only

Conditions: Electronic Health Records

Treatments: Behavioral: Framing

Study type: Interventional

Funder types: Other

Identifiers

NCT07206550

IRB-26-19

Details and patient eligibility

About

The first goal of our research is to understand the effects of different wordings of certain messages on patients' engagement in reviewing their electronic health records (EHRs). These messages will be about EHR errors and their potential consequences, as well as the benefits that might accrue from reviewing EHRs. The second goal is to understand the effects of different wordings of certain messages on patients' discovery and reporting of potential errors in their electronic health records (EHRs).

The main questions it aims to answer are:

1. Does focusing on the negative OR positive consequences of EHR errors in the investigator's messages to people, increase their likelihood of reviewing their EHRs?
2. Does focusing on the negative OR positive consequences of EHR errors in the investigators' messages to people, increase their likelihood of discovery and reporting of potential errors in their EHRs?

First, participants will take an initial short online survey (for about 5 minutes).

Next, participants will be asked to log into their patient portal and review their EHRs, a process that should take around 10 minutes.

Finally, they will proceed with the same survey for an additional 5 minutes, providing responses about their healthcare provider, patient portals, EHR errors, and some basic demographic details.

Full description

This study involves an online experiment aimed at assessing patient engagement in discovering and reporting errors in Electronic Health Records (EHRs). It is being conducted by Dr. Ryan Raimi from the Information Systems Area at The University of Texas at Dallas, in collaboration with Dr. Idris Adjerid from the Business Information Technology Department at Virginia Tech, along with Dr. Anish K. Agarwal and Dr. Raina M. Merchant from the Emergency Medicine Department at the Perelman School of Medicine, University of Pennsylvania. The research involves no deception and presents no more than minimal risk to participants, similar to the risks encountered in everyday life.

Participation typically takes no more than 20 minutes and is completely confidential. To begin, participants will voluntarily consent to take part in the study. If participants agree to participate, the study process will involve the following steps:

Survey Participation: Initially, participants will complete a short survey lasting about 5 minutes, where participants will answer questions about trust, distrust, and privacy concerns.

EHR Review: Next, participants will be instructed to access their patient portal and review their EHRs, which will take approximately 10 minutes.

Final Survey: Afterward, participants will continue the same survey for another 5 minutes, answering questions about their healthcare provider, patient portals, EHR errors, and some basic demographic information.

All responses are kept confidential, and no individual participant data will be identified. The data will be aggregated and published in a summary form only. Although the study is hosted on a secure https server, there is a minimal risk of unauthorized access (e.g., by hackers). Participants' Prolific IDs will not be linked to participants' survey responses, and the investigators will not access any personally identifying information on participants' Prolific Academic profiles.

Participation is voluntary, and choosing not to participate will not affect participants' rights or benefits. Participants may withdraw from the study at any time without penalty or loss of benefits.

Enrollment: 3,000 estimated patients

Sex: All

Ages: 18 to 99 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Subjects should have access to their patient portal
• Subjects should have checked their EHR in the past 12 months

Exclusion criteria

• Not having access to their patient portal
• Not having checked their EHR in the past 12 months

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Double Blind

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3,000 participants in 13 patient groups

Control group

No Intervention group

Description:

The participants in this arm will not receive any message, encouraging them to review their EHRs and report any potential errors.

Gain Framing x Egocentric x "Errors"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "errors", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an error in your EHR. This is a great opportunity to act as your own best advocate, check your EHRs to identify any potential errors, and improve your health outcomes."

Treatment:

Behavioral: Framing

Loss Framing x Egocentric x "Errors"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "errors", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an error in your EHR. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save yourself from experiencing the preventable negative consequences of having a potential error in your EHR."

Treatment:

Behavioral: Framing

Gain Framing x Allocentric x "Errors"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "errors", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an error in your EHR. Such errors can also affect those close to us not just ourselves. This is a great opportunity to act in the interest of your loved ones by improving your health outcomes via checking your EHRs to identify any potential errors. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing

Loss Framing x Allocentric x "Errors"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "errors", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an error in your EHR. Such errors can also affect those close to us not just ourselves. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save your loved ones from experiencing the preventable negative consequences of having a potential error in your EHR. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing

Gain Framing x Egocentric x "Unintended Mistakes"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "unintended mistakes", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an unintended mistake in your EHR. This is a great opportunity to act as your own best advocate, check your EHRs to identify any potential unintended mistakes, and improve your health outcomes."

Treatment:

Behavioral: Framing

Loss Framing x Egocentric x "Unintended Mistakes"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "unintended mistakes", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an unintended mistake in your EHR. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save yourself from experiencing the preventable negative consequences of having a potential unintended mistake in your EHR."

Treatment:

Behavioral: Framing

Gain Framing x Allocentric x "Unintended Mistakes"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "unintended mistakes", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an unintended mistake in your EHR. Such unintended mistakes can also affect those close to us not just ourselves. This is a great opportunity to act in the interest of your loved ones by improving your health outcomes via checking your EHRs to identify any potential unintended mistakes. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing

Loss Framing x Allocentric x "Unintended Mistakes"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "unintended mistakes", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an unintended mistake in your EHR. Such unintended mistakes can also affect those close to us not just ourselves. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save your loved ones from experiencing the preventable negative consequences of having a potential unintended mistake in your EHR. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing

Gain Framing x Egocentric x "Inaccuracies"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "inaccuracies", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an inaccuracy in your EHR. This is a great opportunity to act as your own best advocate, check your EHRs to identify any potential inaccuracies, and improve your health outcomes."

Treatment:

Behavioral: Framing

Loss Framing x Egocentric x "Inaccuracies"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "inaccuracies", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an e inaccuracy in your EHR. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save yourself from experiencing the preventable negative consequences of having a potential inaccuracy in your EHR."

Treatment:

Behavioral: Framing

Gain Framing x Allocentric x "Inaccuracies"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "inaccuracies", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an inaccuracy in your EHR. Such inaccuracies can also affect those close to us not just ourselves. This is a great opportunity to act in the interest of your loved ones by improving your health outcomes via checking your EHRs to identify any potential inaccuracies. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing

Loss Framing x Allocentric x "Inaccuracies"

Active Comparator group

Description:

The participants in this arm will receive the following message using the term "inaccuracies", encouraging them to review their EHRs and report any potential errors: "If you review your medical record, there is a 20% risk of having an inaccuracy in your EHR. Such inaccuracies can also affect those close to us not just ourselves. Taking no action could lead to severe health-related consequences and occasionally be deadly. Act now and save your loved ones from experiencing the preventable negative consequences of having a potential inaccuracy in your EHR. Your loved ones will thank you for prioritizing your safety."

Treatment:

Behavioral: Framing