A hospital integrated patient photos into the electronic health record (EHR), reducing wrong-patient order entries by 35%.

  • Some EHRs may not accept patient photos.
  • The project was inexpensive.
  • Most patients agree to provide a photo.

Wrong-patient order entry is a constant threat to patient safety. A team at Brigham and Women’s Hospital in Boston launched a project to add patient photos to the electronic health record (EHR). Two years later, the error rate had decreased by 35%.

The team purchased six cameras for less than $2,000, which physicians and staff used to take headshots of 19,091 participating patients who visited the emergency department (ED). Those photos were integrated into the EHR as a permanent part of the patient record. (The team’s report on the project is available online at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772798.)

An analysis of more than 2.5 million orders for errors revealed the sharp decline in wrong-patient orders, says Hojjat Salmasian, MD, PhD, MPH, a researcher at the hospital.

Including a patient photo in the EHR may sound like an obvious benefit to ensuring accuracy, but it is not common, Salmasian explains. Some EHR software does not offer the capability to add photos, and some added it only recently.

“Even if your EHR has a lot of features and capabilities, you need to be convinced that they are valuable before you start uploading them to your patient records,” he says. “Unfortunately, with photos, there was not much evidence prior to our research. One previous study found that when photos were used in a pediatric setting, the number of voluntarily reported wrong patient orders was less than the year prior, but the challenge is that voluntary reporting is not a good mechanism to track adverse events.”

Photos at Registration

Salmasian and colleagues used the retract-and-reorder method, which is fully automatable, to take advantage of all the data in the EHR.

“The capability in the EHR was not always there, and we did not always have a good method of measuring the results. But now those issues have changed, and I’m hopeful that a lot more hospitals are able to integrate photos,” Salmasian says. “Anecdotally, I know that more places are doing it in recent years. I hope we will see not just the impact on patient safety, but also on experience of care and other factors.”

The primary challenge in the project was the acquisition of the photos, Salmasian says. At Brigham and Women’s, the project team asked the registration department to discuss the patient safety aspect with patients and request consent for a photo, which the registrar then uploaded to the EHR.

“The No. 1 challenge is how to align these efforts and make sure you’re getting photos for all of your patients,” he says. “There also is a question of whether it is an equitable solution. We did see a slight difference across different race categories — not substantial enough for us to be concerned, but it could be signaling a difference in the willingness of our patients for their pictures to be taken.”

Overall, few patients declined once they understood the patient safety reason and were assured the photo will be part of a confidential record.

Brigham and Women’s suspended photo-taking during the pandemic because it was not safe to ask patients to remove their masks, but plans to resume the process as soon as possible. The hospital also is looking at photos taken early in the project that might be of lower quality because they were not obtained with the more recent software that standardizes and optimizes the images. A software program is scanning the images to find those that might need to be updated.

Patients Can Upload

Brigham and Women’s used webcam-type cameras and handheld devices with its EHR that included built-in options to help obtain high-quality, standardized photos to upload to the EHR. Another option is to ask patients to upload photos through the patient web portal.

“That option is good if you want to allow the patient to upload pictures more frequently, or if the picture in the hospital is of the patient looking very ill and they prefer a more representative picture of them looking normal, they can replace it with a better picture,” Salmasian says.

“One aspect of this work that is important is that patients can upload their photos through the portal. By doing that, they can play a very direct role in how safe the care they receive is, as well as the care of other patients,” he adds. “Another patient avoids a wrong-patient error, so that patient engagement factor is an important aspect of this.”


  • Hojjat Salmasian, MD, PhD, MPH, Brigham and Women’s Hospital, Boston. Phone: (617) 732-5500.