Patient Identification of Diagnostic Safety Blindspots and Participation in “Good Catches” Through Shared Visit Notes

Abstract

Patients and families can identify clinically relevant errors, including “blindspots”—safety hazards that are difficult for clinicians or organizations to see. Health information transparency, including patient access to electronic visit notes, now federally mandated in the US and the subject of policy debate worldwide, creates a new opportunity to engage patients in diagnostic safety. However, not all patients access notes. Patient identification of blindspots in their notes underscores the need to systematically and equitably engage willing patients in safety, promote patient “good catches,” and establish routine systems for patient feedback to help avoid preventable diagnostic errors and delays. Context Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of “diagnostic safety blindspots”—potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe. Method We used mixed methods to analyze patient‐reported ambulatory documentation errors among 22,889 patients at three US health care centers who read ≥ 1 visit note(s). We identified blindspots by tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification. Findings 774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n = 421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low‐level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in “good catches” that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in health care were more likely to identify a blindspot. Individuals reporting less formal education; those self‐identifying as Black, Asian, other, or multiple races; and participants who deferred decision‐making to providers were less likely to report a blindspot. Conclusion Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning but may not be known to clinicians—underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patient‐reported blindspots, and promote equity in note access and blindspot reporting.

Real world challenges in maintaining data integrity in electronic health records in a cancer program

“…As sarcoma patient care is shared by 2 institutions with independent EHRs, additional efforts would be needed to accurately transfer and record reports in the patient’s electronic charts. Additionally, patient engagement in their own health record keeping could further ensure the accuracy of the data within EHRs [9] . Institution specific patient portals along with independent person-centered health platforms would allow patients to partner and participate in their own EHR upkeep.…”

“…Prior reports on the rate of documentation errors in patient charts [8] , [9] , [10] have suggested that approximately 40 % of patient charts contained serious mistakes, of which diagnosis misalignment is the most common mistake category. Using a Natural Language Processing method, Warner et al observed 83.6 % of cancer patients had discordant cancer stages within their charts [11] .…”

“…Physician could also verify the accuracy and completeness of the patient’s EHR information in real-time together with the patient and caregivers [20] . Finally, patient access to EHR records and their active engagement may decrease documentation error rate [9] , through their collaboration in reporting disconnects between their understanding and what was described in their own clinical notes.…”

Point‐counterpoint: Time to wash away the SOAP note—Or merely rinse it?

“…For one, in medical education, SOAP note content is an ideal means of assessing clinical reasoning 18 . Further, patient access to documentation improves diagnosis by identifying “diagnostic safety blindspots.” 19 One study found that many patients acted on the blindspots they identified by reviewing shared notes, resulting in “good catches” that may prevent potential negative consequences 19 . SOAP notes are an effective tool that aids in the complex process of clinical reasoning.…”

Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference

“…29 Innovations to engage patients in diagnosis therefore require a focus on promoting equity and principled data collection to examine disparities in use. 16,36 To date little is known about how to engage patients and families of diverse races, ethnicities, or language preferences in the DxP.…”