Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

Powell, Lauren; Sittig, Dean F.; Chrouser, Kristin; Singh, Hardeep

doi:10.1001/jamanetworkopen.2020.6752

Cited by 20 publications

(17 citation statements)

References 74 publications

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“…A full-text review of these articles determined that 11 explicitly documented a relationship between EHR use and diagnostic error. [15][16][17][18][19][20][21][22][23][24][25] The summary of study characteristics for these 11 articles can be found in Table 2. Most articles (n = 9; 81.8%) focused on diagnostic errors in ambulatory or primary care settings.…”

Section: Summary Of Reviewed Articlesmentioning

confidence: 99%

Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework

et al. 2023

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Background: Diagnostic errors are a major source of patient harm, most of which are caused by cognitive errors and biases. Despite research showing the relationship between software systems and cognitive processes, the impact of the electronic health record (EHR) on diagnostic error remains unknown. Methods:We conducted a scoping review of the scientific literature to (1) survey the association between aspects of the EHR and diagnostic error, and (2) through a human-systems integration lens, identify the types of EHR issues and their impact on the stages of the diagnostic process. Results:We analyzed 11 research articles for the relationship between EHR use and diagnostic error. These articles highlight specific technical, usability, and workflow issues with the EHR that pose risks for diagnostic error at every stage of the diagnostic process.Discussion: Although technical problems such as EHR interoperability and data integrity pose critical issues for the diagnostic process, usability and workflow issues such as poor display design, and inability to track test results also hamper clinicians' ability to track, process, and act in the diagnostic process. Current research methods have limited coverage over clinical settings, are not standardized, and rarely include measures of patient harm. Conclusions:The available evidence shows that EHRs pose risks for diagnostic error throughout the diagnostic process, with most issues involving their incompatibility with providers' cognitive processing. A structured and systematic model of collecting and reporting on these errors is needed to understand how the EHR shapes the diagnostic process and improve diagnostic accuracy.

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Section: Summary Of Reviewed Articlesmentioning

confidence: 99%

Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework

et al. 2023

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“…Participants in each room were asked to work on one of 3 feedback interventions we developed from the literature in the problem domain [18][19][20][21][22]. For purposes of our project, we labeled each of the 3 intervention types as follows: "social" (ie, a conversation guide for one's supervisor), "technical" (ie, an electronic data dashboard), and "sociotechnical" (ie, an email message or template).…”

Section: Virtual Roomsmentioning

confidence: 99%

Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach

Savoy¹,

Patel²,

Shahid³

et al. 2022

JMIR Hum Factors

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Background Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians’ commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. Objective The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. Methods We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. Results A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. Conclusions ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions.

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“…Evidence-based strategies to prevent medication errors, failures in teamwork, problems with communication and coordination, and breakdowns in follow-up of test results and referrals have emerged but havebeenimplementedinconsistently. 1,6 Toclosegapsbetweenknowledge and implementation, outpatient practices need dedicated time, training, incentives, and resource support. To enable change, large integrated delivery systems could leverage their infrastructure to create ambulatorysafetyprogramsandbecomelearningcentersthattestand implement safety strategies.…”

Section: Practice Milestonesmentioning

confidence: 99%

A Roadmap to Advance Patient Safety in Ambulatory Care

Singh

Carayon

2020

JAMA

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Advances in patient safety in the past 2 decades have focused mainly on inpatient settings, whereas outpatient settings have been relatively overlooked. However, accumulated evidence leaves little justification to continue neglecting ambulatory safety. 1 A systematic review from 2015 estimated that safety incidents, such as those related to administrative and communication issues, missed or delayed diagnoses, and prescribing and medication management errors, occur in median of 2 to 3incidentsper100primarycarevisits. 2 Otherstudieshave estimated that 5% of US adult outpatients may have experienced a diagnostic error annually 3 and that a projected 4.5 million ambulatory care visits annually in the US may have been related to an adverse drug event. 4 Although errors in ambulatory settings are less likely to lead to immediate harm than errors in acute/inpatient care, their health consequences may be significant nonetheless (eg, from missed cancer diagnosis). Recognizing the need to address outpatient safety, reports from national and international groups have offered an impetus to measure ambulatory patient harm, prioritize nearterm goals, and create high-profile initiatives similar to those for inpatient settings. 1 Several barriers limit progress toward next steps. Care fragmentation and inadequate data systems make it difficult to map longitudinal patient experience in and across multiple settings (eg, primary/specialty care, patient home, diagnostic testing, community-pharmacy), hindering detection and assessment of safety problems. Consider a patient who, after visiting primary care and multiple specialty care settings, 2 laboratories, an imaging center, and an ambulatory surgery center, is diagnosed with lung cancer 1 year after initially presenting with fatigue and weight loss. Identifying this event and then determining sources of diagnostic delay in this patient's clinical course is a challenging task, even if medical records from each setting are easily accessible. Resources, infrastructure for measurement and analytics, and accreditation requirements for safety are less developed for ambulatory settings compared with inpatient settings. Additionally, patients can have complex presentations that include undifferentiated symptoms, multiple chronic conditions, and social needs that warrant attention in time-pressured, information-poor work environments.While the limitations of existing measurement methods have made it difficult to precisely quantify the overall prevalence of harm, evidence suggests that medication errors, diagnostic errors, and communication and coordination breakdowns are the most common causes of preventable harm among outpatients. The scope and consequences of harm include physical, psychological, and financial harms to patients, caregivers, health care workers, and society. A roadmap of milestones is needed to accelerate progress (eFigure in the Supplement).

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Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

Cited by 20 publications

References 74 publications

Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework

Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework

Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach

A Roadmap to Advance Patient Safety in Ambulatory Care

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