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Ghost charts and shadow records: implication for system design.

¹School of Communication, Simon Fraser University, Burnaby, British Columbia, Canada.

Studies in Health Technology and Informatics

|September 16, 2010

Summary

Ghost charts, or duplicate medical records, pose patient safety risks. Addressing their underlying functions is crucial for eliminating them and improving clinical information systems.

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Last Updated: Jun 8, 2026

Evaluating Usability Aspects of a Mixed Reality Solution for Immersive Analytics in Industry 4.0 Scenarios

Evaluating Usability Aspects of a Mixed Reality Solution for Immersive Analytics in Industry 4.0 Scenarios

Published on: October 6, 2020

Area of Science:

Health Informatics
Patient Safety
Clinical Information Systems

Background:

Ghost charts, also known as shadow charts, are duplicate medical records that pose significant risks to patient safety.
Their existence is widespread despite governance documents advising against them, primarily due to unaddressed functional needs.

Purpose of the Study:

To investigate the reasons behind the persistence of ghost charts in ambulatory care settings.
To inform the design and implementation of clinical information systems aimed at eliminating the need for duplicate records.

Main Methods:

A multi-method qualitative study was conducted in two ambulatory care settings within a Canadian hospital.
In-depth analysis of ghost chart usage and the needs they fulfill was performed.

Main Results:

Ghost charts serve various functions, many of which are not typically considered in standard electronic record system design.
The study identified specific needs that, if not met by new systems, will likely perpetuate the use of ghost charts.

Conclusions:

Eliminating ghost charts requires clinical information systems to address the diverse functions these duplicate records currently fulfill.
Understanding the underlying reasons for ghost chart use is essential for designing effective electronic health record systems and enhancing patient safety.