Use of health information technology to reduce diagnostic errors

Abstract

BackgroundHealth information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions.Methods A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified.ResultsHIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact.ConclusionsDiagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.

Denkfehler bei diagnostischen Entscheidungen

“…Letztere bieten ein großes Potential an Möglich-keiten und werden den ärztlichen Alltag vermutlich noch mehr beeinflussen, als man es sich derzeit vorstellen kann [2,52,53] …”

Next steps for electronic health records to improve the diagnostic process

“…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.…”

Medical Scribes: Salvation for Primary Care or Workaround for Poor EMR Usability?

“…8 To the extent that clinical notes are relegated to mere "paperwork" to quickly document and close the encounter, rather than be conceptualized as an opportunity for clinicians to take the time to reflect on their assessment and plan, (at times better done better after the rushed pace of the clinic session is over), then something is lost when we streamline documentation via scribed notes. 9 Although nothing precludes creative ways and roles scribes could play in this vision of clinical documentation, we challenge those effectively using and working with scribes to help imagine and design new workflow to enhance the quality of the note "Assessment" section.…”