EHRs can be used to identify which primary care visits are likely to be associated with diagnostic errors, according to a new study in JAMA Internal Medicine (formerly Archive of Internal Medicine).
The researchers, from several facilities and institutions in the Houston, TX, hypothesized that diagnostic errors were an important but understudied aspect of ambulatory patient safety.
They studied 190 instances of diagnostic errors from a large integrated private health care system and an urban VA facility, using EHR-based triggers, such as unplanned hospitalizations, return visits or emergency department visits shortly after a patient had a primary care encounter. They found 68 unique diagnoses missed by the primary care practitioners. The most common diagnoses missed were pneumonia, congestive heart failure, acute renal failure, cancer, and urinary tract infections.
The researchers also found that the most common process breakdowns leading to diagnostic errors arise within the patient/practitioner encounter, such as ordering tests, taking medical histories or performing physical exams.
"Our findings highlight the need to focus on basic clinical skills and related cognitive processes (eg, data gathering within the medical history and physical examination and synthesis of data) in the age of increasing reliance on technology and team-based care to improve the health care system," the researchers said.
They also noted that current EHR technology was "inadequately positioned to meet the needs of complex decision making."
While EHRs may help identify patient safety issues, they can also create new or additional patient safety hazards, an issue that both the Institute of Medicine and HHS has addressed in recent months.
To learn more:
- read the study