Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology

Singh, Hardeep; Naik, Aanand D.; Rao, Raghuram; Petersen, Laura A.

doi:10.1007/s11606-007-0393-z

Cited by 139 publications

(101 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this could lead to a Bfresh^perspective, it also hindered the clinicians' ability to assess changes over time and likely decreased the quality of information transfer. 36 Moreover, numerous hospitalizations and diagnostic tests made the patient's medical record long and cumbersome to review, potentially contributing to communication breakdown. It also likely led subsequent providers to miss key details earlier in the patient's presentation, potentially excluding unrecognized pertinent information.…”

Section: Discussionmentioning

confidence: 99%

Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin

et al. 2016

View full text Add to dashboard Cite

Dermatomyositis is a chronic systemic autoimmune disease characterized by inflammatory infiltrates in the skin and muscle. The wide variability in clinical and serologic presentation poses a diagnostic challenge for the internist. Appreciation of the clinical variants of dermatomyositis allows for expedient diagnosis and avoidance of diagnostic error. We illustrate these challenges with the case of a 51-year-old VietnameseAmerican man who initially presented with fever of unknown origin in the absence of overt skin and muscle manifestations. The diagnosis of dermatomyositis was not evident on several clinical encounters due to the absence of these hallmark symptoms. We review the variable clinical manifestations of a subtype of dermatomyositis associated with an autoantibody against melanoma differentiation-associated protein 5 (anti-MDA5) and suggest consideration of dermatomyositis as a diagnosis in patients presenting with systemic illness and markedly elevated ferritin, even in the absence of elevated muscle enzymes and classic autoantibodies. CASE PRESENTATIONA 51-year-old Vietnamese-American male industrial engineer was admitted to the medical ward for evaluation of fever of unknown origin (FUO). He reported 3 weeks of fever, fatigue, generalized weakness, and dyspnea. His past medical history included a remote 10-pack-year history of cigarette smoking and latent tuberculosis treated with 9 months of isoniazid treatment, completed 5 years prior. He had moved from Vietnam to the United States 30 years earlier and denied any recent travel, sick contacts, or insect bites. Physical examination revealed a fatigued man, with a temperature of 38.1°C, pulse of 108 beats/minute, respiratory rate of 28 breaths/minute, and room air oxygen saturation of 96 %. Oropharyngeal, neurologic, pulmonary, cardiac, musculoskeletal, and skin evaluation were otherwise normal.A complete blood count (CBC) revealed anemia (hemoglobin 12.3 g/dL, hematocrit 38.5 %). White blood cell counts, platelet counts, and the basic metabolic panel were normal. Erythrocyte sedimentation rate (ESR) was 97 mm/hr and C-reactive protein (CRP) was 5.7 mg/dL. Muscle enzymes, sent to evaluate his weakness in the setting of elevated inflammatory markers, showed normal creatine kinase (CK) at 44 units/liter and mildly elevated aldolase to 9.4 U/L (normal: < 7.7 U/L). Blood, urine, and sputum cultures had no growth. Chest x-ray (CXR) demonstrated low lung volumes with increased reticular markings, small bilateral pleural effusions, and bibasilar opacities. During the hospitalization, he continued to have intermittent fevers as high as 39.1°C, generalized weakness, and dyspnea. Additionally, he developed bibasilar crackles on pulmonary exam and flat, diffuse, slightly hyperpigmented patches on his arms and chest that faded over several days. Extensive workup for infectious, inflammatory, and malignant causes of fever was unrevealing, including negative viral hepatitis serologies, human immunodeficiency virus antibody, anti-nuclear antibody (ANA), and anti-...

show abstract

Section: Discussionmentioning

confidence: 99%

Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Unfortunately, even with this more narrow focus of improving diagnosis through use of EHRs, how best to achieve this is not yet clear. Limited evidence exists to support alerts, selected triggers, patient panel management and diagnostic protocols to prevent diagnostic error [18][19][20]. Unfortunately, the evidence basis remains scant for many of the tactics by which technology could theoretically improve the diagnostic process.…”

Section: Electronic Health Record (Ehr) Adoption In the Unitedmentioning

confidence: 99%

“…Table 1 shows some of these possibilities and was created to complement the DEER taxonomy but focuses on EHR usage [20]. In particular, strategic use of EHRs in the following categories appears potentially beneficial to the diagnostic process: documentation, care coordination, patient engagement, automation, physician and patient checklists, next step guidance, redundancy avoidance, monitoring, and broadened differential diagnoses [10,16,[18][19][20]22]. For example, when applied judiciously and in the appropriate workflow context, diagnostic error triggers already have a growing body of evidence behind their benefits [18,23].…”

Section: Electronic Health Record (Ehr) Adoption In the Unitedmentioning

confidence: 99%

Next steps for electronic health records to improve the diagnostic process

Liebovitz

2015

Diagnosis

View full text Add to dashboard Cite

Electronic health record (EHR) usage is accelerating while preventable diagnostic error persists. EHRs may even contribute to diagnostic error through several pathways including poor usability and an over reliance on electronic chart based communication. The changing context of healthcare delivery offers potential financial incentives for organizations to leverage EHRs to reduce diagnostic error. The lack of standard quality metrics for reporting rates of diagnostic error, a lack of diagnostic feedback systems for physicians and organizations, and a lack of compelling evidence for specific interventions underscore the need for further research in preventing diagnostic error. Many potential strategies exist for EHRs to reduce the likelihood of diagnostic error. Practical next steps for leveraging EHR systems to assist in the diagnostic process are suggested. These include patient engagement strategies, closed loop result tracking, targeted next step reminder systems, and expansion of a list of actionable patient states based on diagnosis triggers.

show abstract

“…[1][2][3][4][5][6][7][8][9] Test result management in an electronic health record (EHR)-enabled health care system is susceptible to both technological and non-technological vulnerabilities. 10,11 EHR-based test result notification systems are aimed at reducing delays in follow-up of abnormal test results, and likely represent an improvement over communication using paper-based methods.…”

Section: Introductionmentioning

confidence: 99%

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

et al. 2017

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. OBJECTIVE: To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. DESIGN: We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. KEY RESULTS: During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). CONCLUSIONS: An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

show abstract

Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology

Cited by 139 publications

References 60 publications

Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin

Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin

Next steps for electronic health records to improve the diagnostic process

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

Contact Info

Product

Resources

About