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

Conditions

• Electronic Health Records

Eligibility Criteria

Sex

ALL

Age

18 Years - 99 Years

Healthy Volunteers

Accepted

Interventions

• Framing — BEHAVIORAL
  The participants will receive different messages using different terms and behavioral framings, encouraging them to review their EHRs and report any potential errors. These wording variations are expected to induce variance in subjects' behaviors with regard to the likelihood of reviewing EHRs, as well as discovering and reporting potential errors in them.

Study Details

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.

Key Dates

Start date

Nov 26, 2025

Status verified

Jun 2026

Primary completion

Jul 30, 2026

Completion

Aug 10, 2026

Study Design

Enrollment

3,000 participants (estimated)

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

OTHER

Arms

• No Intervention: Control group
  The participants in this arm will not receive any message, encouraging them to review their EHRs and report any potential errors.
• Active Comparator: Gain Framing x Egocentric x "Errors"
  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."
• Active Comparator: Loss Framing x Egocentric x "Errors"
  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."
• Active Comparator: Gain Framing x Allocentric x "Errors"
  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."
• Active Comparator: Loss Framing x Allocentric x "Errors"
  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."
• Active Comparator: Gain Framing x Egocentric x "Unintended Mistakes"
  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."
• Active Comparator: Loss Framing x Egocentric x "Unintended Mistakes"
  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."
• Active Comparator: Gain Framing x Allocentric x "Unintended Mistakes"
  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."
• Active Comparator: Loss Framing x Allocentric x "Unintended Mistakes"
  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."
• Active Comparator: Gain Framing x Egocentric x "Inaccuracies"
  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."
• Active Comparator: Loss Framing x Egocentric x "Inaccuracies"
  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."
• Active Comparator: Gain Framing x Allocentric x "Inaccuracies"
  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."
• Active Comparator: Loss Framing x Allocentric x "Inaccuracies"
  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."

Primary Outcome Measure

Reviewing EHRs [ Time Frame: From starting the initial survey through study completion, an average of 20 minutes ]

Locations (1)

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