Can data in electronic medical records be trusted?

If the subject is respiratory rates, the answer is “No” according to a recent study. The authors reviewed the records of 28,500 patients over 220,000 hospital days and found recorded maximum respiratory rates “were not normally distributed but were right skewed with values clustered at 18 to 20 breaths per minute.”

The figure below shows maximum respiratory rates compared to heart rates which were normally distributed.

Reminder: Most sources say the normal respiratory rate of an adult ranges from 12 to 20 breaths per minute.

Other unusual findings were as follows. During 75% of hospital days, the maximum respiratory rate was 18 or 20, minimum and maximum respiratory rates were equal on 26% of days, and variations in rates decreased over the course of hospitalizations.

Respiratory rates did not vary much “even among those with cardiopulmonary compromise or immediately prior to ICU transfer.”

In their discussion, the authors pointed out that these inaccuracies may result in patients who are becoming tachypneic—say with respiratory rates rising from 12 to 14 to 20—being discovered too late to avoid intensive care.

The study is limited because it was impossible to know if individual respiratory rates were measured correctly. However, the abnormal distribution with rates of mainly 18 and 20 and similar variations regardless of clinical condition seem convincing.

The findings raise a question. Does the electronic medical record contain other inaccurate data?

I believe so. What do you think?

Thanks to Twitter friend @MaryDixonWoods for letting me know about the study