The DOI matches its Crossref record; 75 of the 76 references it cites were found in a registry or an index; 4 of the 93 sources its claims cite were checked for support.
Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology
Open accessAbstract
Diagnostic errors are poorly understood despite being a frequent cause of medical errors. Recent efforts have aimed to advance the "basic science" of diagnostic error prevention by tracing errors to their most basic origins. Although a refined theory of diagnostic error prevention will take years to formulate, we focus on communication breakdown, a major contributor to diagnostic errors and an increasingly recognized preventable factor in medical mishaps. We describe a comprehensive framework that integrates the potential sources of communication breakdowns within the diagnostic process and identifies vulnerable steps in the diagnostic process where various types of communication breakdowns can precipitate error. We then discuss potential information technology-based interventions that may have efficacy in preventing one or more forms of these breakdowns. These possible intervention strategies include using new technologies to enhance communication between health providers and health systems, improve patient involvement, and facilitate management of information in the medical record.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This conceptual paper argues that communication breakdown is a major preventable contributor to diagnostic errors and proposes a three-level framework linking diagnostic steps, communication types, and breakdown points to guide IT-based interventions. It catalogs 12 possible communication error types and discusses EMR/PHR, alerting, tracking, email, and shared decision-making strategies, while cautioning that IT alone cannot assure safer diagnosis.
Key findings
- Diagnostic errors are frequent and costly: about 40% of all malpractice payments in 2003 were diagnosis-related, with an average payment of approximately $300,000 per claim; one study of 49,345 malpractice claims from 1985–2000 found over one-third caused by diagnostic error, and 1 in 6 subjects in a National Patient Safety Foundation poll claimed personally experiencing diagnostic error.
- Communication breakdowns are common in diagnosis: over a third of women with abnormal mammograms did not receive appropriate follow-up; 68% of specialists reported receiving no information from the primary care physician before the referral visit, and 25% of primary care physicians reported still having no information from specialists 4 weeks after referral visits.
- The paper proposes a framework combining 3 diagnostic steps (data gathering, data integration, diagnosis verification), 2 communication types (interpersonal and informational), and 3 breakdown types (message transmission, reception, acknowledgement), yielding 12 possible communication error types across data gathering and diagnosis verification.
- Proposed IT interventions include EMRs, personal health records, electronic alerts, tracking of abnormal results and consultations, direct reporting of test results, secure email, and shared decision-making tools; however, the authors state IT-based interventions alone cannot assure improvement and computerized systems themselves can lead to unintended communication errors.
Methods
- Design: conceptual/review article that develops a framework and discusses potential IT-based interventions; no empirical study or trial is reported.
- Data or sample: no primary dataset or patient sample; the paper draws on cited literature and illustrative examples, including 12 examples in Table 1.
- Main analysis: narrative synthesis and conceptual framework development linking diagnostic steps, communication types, and breakdown points to proposed IT strategies.
Limitations
- Stated in the paper: the true prevalence of diagnostic error is unknown; relatively little is known about causes and prevention; a refined cognitive theory of diagnostic decision making will require years; IT-based interventions alone cannot assure improvements and may introduce unintended errors; physician adoption of email is generally low and several barriers exist.
- Evident from the text: the proposed framework and 12 communication error types are not empirically tested in this paper, and no outcome data are provided on the efficacy of the proposed IT interventions.
- Evident from the text: the examples in Table 1 are illustrative scenarios rather than validated case series or measured outcomes.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
40 Not checked yet · 13 Own interpretation · 2 Supported · 1 Supported so far · 1 Partly supported · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“For example, in a study of abnormal mammograms, over a third of the women studied did not receive appropriate follow-up.30”
What the sources say
- Supportedcites [30] Poon EG, Haas JS, Louise PA, Gandhi TK, Burdick E, Bates DW, Brennan TA. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19:316–23. source
The Results report that 45 of 126 women (36%) did not receive appropriate and timely follow-up, which is over a third. The study concerned abnormal mammograms requiring short-term follow-up. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a recent study, the internet proved to be a remarkably effective and accurate mechanism for enhancing peer communication.67”
What the sources say
- Partly supportedcites [67] Esquivel A, Meric-Bernstam F, Bernstam EV. Accuracy and self correction of information received from an internet breast cancer list: content analysis. BMJ. 2006;332:939–42. sourceExperimental — accuracy not yet measured
The Results and Discussion report that few posts on one breast cancer mailing list were false or misleading, and that participants corrected seven of ten such statements. The paper does not measure whether the internet enhanced peer communication, and its Discussion cautions that findings from this single forum may not generalise to others. Page numbers are not available in our copy. (LLM, conf=0.85)
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Although direct reporting to patients may prevent loss of follow-up”
What the sources say
- Supportedcites [55] Sung S, Forman-Hoffman V, Wilson MC, Cram P. Direct reporting of laboratory test results to patients by mail to enhance patient safety. J Gen Intern Med. 2006;21:1075–8. source
The paper’s conclusion states that direct reporting of selected test results to patients is a way to ensure important results are not missed. This supports the citing sentence’s hedged claim that direct reporting may prevent loss of follow-up; the paper does not claim it has demonstrated that effect for all tests. (LLM, conf=0.93)
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“and provides opportunities to improve the efficiency of clinical time use.58,59”
What the sources say
- Supportedcites [58] Leong SL, Gingrich D, Lewis PR, Mauger DT, George JH. Enhancing doctor–patient communication using email: a pilot study. J Am Board Fam Pract. 2005;18:180–8. source
The Abstract reports that patients spent less time contacting their physicians, while physicians’ time answering messages did not increase. The Discussion also describes email as a way to manage some patient concerns beyond office visits. Together, these support the qualified claim that email offers opportunities to use clinical time more efficiently. (LLM, conf=0.88)
- Not checked yetcites [59] Mandl KD, Kohane IS, Brandt AM. Electronic patient–physician communication: problems and promise. Ann Intern Med. 1998;129:495–500. source
plainconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- Supported
None of the sources cited for this claim have been checked yet.
In the paper
“IT-based interventions alone, however, cannot assure improvements in communication.”
What the sources say
- Not checked yetcites [25] Singh H, Arora HS, Vij MS, Rao R, Khan M, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459–66. source
- Not checked yetcites [34] Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11:104–12. source
- Not checked yetcites [42] Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13:547–56. source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Communication breakdowns are an increasingly recognized preventable factor in medical mishaps, and emerging data suggest a high prevalence of communication breakdowns among physicians, patients, and important members of the health care team who assist with the diagnostic process.21,25–32”
What the sources say
- Not checked yetcites [21] Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142:352–8. source
- Not checked yetcites [25] Singh H, Arora HS, Vij MS, Rao R, Khan M, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459–66. source
- Not checked yetcites [26] Boohaker EA, Ward RE, Uman JE, McCarthy BD. Patient notification and follow-up of abnormal test results. A physician survey. Arch Intern Med. 1996;156:327–31. source
- Not checked yetcites [27] Brenner RJ, Bartholomew L. Communication errors in radiology: a liability cost analysis. J Am Coll Radiol. 2005;2:428–31. source
- Not checked yetcites [28] Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15:626–31. source
- Not checked yetcites [29] Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866–72. source
- Not checked yetcites [30] Poon EG, Haas JS, Louise PA, Gandhi TK, Burdick E, Bates DW, Brennan TA. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19:316–23. source
- Not checked yetcites [31] Schiff GD. Introduction: communicating critical test results. Jt Comm J Qual Patient Saf. 2005;31:63–5. source
- Not checked yetcites [32] Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79:186–94. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, addressing preventable communication breakdowns by using resources such as information technology offers a viable and timely opportunity to improve the diagnostic quality.”
plainconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“Little is known about the precise cognitive processes that physicians use to confirm and reject their diagnostic hypotheses,20”
What the sources say
- Not checked yetcites [20] Sox HC, Blatt MA, Higgins MC, Marton KI. Medical Decision Making. Stoneham, MA: Butterworth-Heinemann; 1988.
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“and diagnostic difficulties persist despite practitioner experience and advances in diagnostic tests.23,24”
What the sources say
- Not checked yetcites [23] Kuhn GJ. Diagnostic errors. Acad Emerg Med. 2002;9:740–50. source
- Not checked yetcites [24] Friedman CP, Gatti GG, Franz TM, et al. Do physicians know when their diagnoses are correct? Implications for decision support and error reduction. J Gen Intern Med. 2005;20:334–9. source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Although diagnostic errors may occur when signs of a disease are atypical or absent, diagnostic errors are often attributed to cognitive (e.g., faulty clinical reasoning) and/or systems-related factors (e.g., inefficient processes and poor communication7,9–21).”
What the sources say
- Not checked yetcites [7] Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165:1493–9. source
- Not checked yetcites [9] Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145:488–96. source
- Not checked yetcites [10] Croskerry P. Diagnostic failure: a cognitive and affective approach. AHRQ . 2005. Available at Available at: http://www.ahrq.gov/downloads/pub/advances/vol2/Croskerry.pdf . Accessed 7-2-2007. source
- Not checked yetcites [11] Elstein AS. Heuristics and biases: selected errors in clinical reasoning. Acad Med. 1999;74:791–4. source
- Not checked yetcites [12] Hodder RJ, Ballal M, Selvachandran SN, Cade D. Variations in the evaluation of colorectal cancer risk. Colorectal Dis. 2005;7:254–62. source
- Not checked yetcites [13] Kahneman D, Slovic P, Tversky A. Judgment Under Uncertainty: Heuristics and Biases. Cambridge UK: Cambridge University Press; 1982. source
- Not checked yetcites [14] Klein G. Sources of Power: How People Make Decisions. Cambridge, Massachusetts: The MIT Press; 1998.
- Not checked yetcites [15] McDonald CJ. Medical heuristics: the silent adjudicators of clinical practice. Ann Intern Med. 1996;124:56–62. source
- Not checked yetcites [16] Tanenbaum SJ. What physicians know. N Engl J Med. 1993;329:1268–71. source
- Not checked yetcites [17] Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453–8. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 9
- Probably not a substantial claim. 15
In the paper
“For example, the Situation-Background-Assessment-Recommendation (SBAR) technique implemented widely at health systems such as Kaiser Permanente standardizes communication and reduces breakdowns related to data gathering.40”
What the sources say
- Not checked yetcites [40] Kaiser Permanente of Colorado. SBAR Technique for Communication: A Situational Briefing Model. The Institute for Healthcare Improvement . 2006. Available at http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.htm . Accessed 7-2-2007.
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“In this paper, it is worthwhile to consider the goals of communication in the health care setting: often communication is not only intended to transfer information, but also to generate a response from the recipient of the information, such as taking an action and acknowledging receipt of the information.34”
What the sources say
- Not checked yetcites [34] Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11:104–12. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, all 3 of the above steps, but particularly data gathering and diagnosis verification, rely on good communication and may be targeted for interventions to improve the process of making a correct diagnosis.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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It may state two separate claims as one.
In the paper
“To improve communication and patient safety, the Institute of Medicine has called for redesigning and error-proofing health care delivery systems.36”
What the sources say
- Not checked yetcites [36] Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy Press; 1999.
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“One such study analyzed 49,345 malpractice claims between 1985 and 2000 and found over one-third of the claims to be caused by diagnostic error.2”
What the sources say
- Not checked yetcites [2] Phillips RL Jr, Bartholomew LA, Dovey SM, Fryer GE Jr, Miyoshi TJ, Green LA. Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care. 2004;13:121–6. source
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Large risk-management database studies have shown that out of all liability claims, those related to diagnoses are the most frequent and expensive (about 40% of all malpractice payments in 2003, with an average payment of approximately $300,000 per claim1).”
What the sources say
- Not checked yetcites [1] Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: evidence from the National Practitioner Data Bank. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5. source
boosted- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Using information technology (IT) and adopting electronic medical records (EMR) can significantly improve the quality of information transfer38,39 and reduce failures in several of the pathways we have described.”
What the sources say
- Not checked yetcites [38] Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003;348:2526–34. source
- Not checked yetcites [39] Petersen LA, Orav EJ, Teich JM, O’Neil AC, Brennan TA. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv. 1998;24:77–87.
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Another intervention known as “read-back verification” requires the clinician to repeat the information back to the person who transmitted it, completing the loop of reception and acknowledgement in a verifiable manner.41”
What the sources say
- Not checked yetcites [41] Barenfanger J, Sautter RL, Lang DL, Collins SM, Hacek DM, Peterson LR. Improving patient safety by repeating (Read-Back) telephone reports of critical information. Am J Clin Pathol. 2004;121:801–3. source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although message acknowledgement is not strictly necessary for data synthesis and follow-up action in all cases, acknowledgement facilitates concordance among parties and typically implies that some action will follow.”
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Although the true prevalence of diagnostic error is unknown, 1 in 6 subjects interviewed in a National Patient Safety Foundation poll claimed to have personally experienced diagnostic error.3”
What the sources say
- Not checked yetcites [3] Golodner L. How the public perceives patient safety. Newsletter of the National Safety Foundation. 2004;1997:1–6.
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“One method for achieving this goal is to develop electronic information systems for the delivery of health care data.36,37”
What the sources say
- Not checked yetcites [36] Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy Press; 1999.
- Not checked yetcites [37] Institute of Medicine of the National Academies. Patient Safety: Achieving a New Standard for Care. Washington, D.C.: National Academy Press; 2004.
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“According to Kuhn, the process of making a diagnosis involves 3 sequential, overlapping steps: data gathering, data integration, and verification of diagnosis.23”
What the sources say
- Not checked yetcites [23] Kuhn GJ. Diagnostic errors. Acad Emerg Med. 2002;9:740–50. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Diagnostic errors are a frequent cause of medical errors in the United States.”
What the sources say
- Not checked yetcites [1] Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: evidence from the National Practitioner Data Bank. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5. source
- Not checked yetcites [2] Phillips RL Jr, Bartholomew LA, Dovey SM, Fryer GE Jr, Miyoshi TJ, Green LA. Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care. 2004;13:121–6. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Such errors also appear to be burdensome in the training environment.4–6”
What the sources say
- Not checked yetcites [4] Singh H, Thomas EJ, Khan M, Petersen LA. Identifying diagnostic errors in primary care using an electronic screening algorithm. Arch Intern Med. 2007;167(3):302–8. source
- Not checked yetcites [5] Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007 Oct 22;167(19):2030–6. source
- Not checked yetcites [6] Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089–94. source
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Focusing interventions on diagnostic steps that are prone to communication breakdowns could achieve a significant reduction in diagnostic errors.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
- Rests on an assumption: Communication breakdowns lead to diagnostic errors.
None of the sources cited for this claim have been checked yet.
In the paper
“Patients can use personal health records (PHRs; secure electronic repositories of health information50) to generate their own medical histories before their visits and integrate selected information with the physician’s EMR at their discretion.51”
What the sources say
- Not checked yetcites [50] Gearon CJ. Perspectives on the Future of Personal Health Records. Health Records . 2007. 7-17-2007. Available at http://www.chcf.org/documents/chronicdisease/PHRPerspectives.pdf . Accessed 7-12-2007.
- Not checked yetcites [51] Medical Net Systems, Inc. Medical Net Systems EMR PHR Integration and Other Advance Features; Executive Summary. Medical Net Systems, Inc. 2007. Available at http://www.medicalnetsystems.com/index/EMR_PHR_Integration . Accessed 7-12-2007.
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Multidisciplinary IT-based strategies that integrate the science of physician–patient communication and health informatics can offer a pragmatic approach to reduce diagnostic errors in health care.”
plainconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
- Rests on an assumption: Communication breakdowns lead to diagnostic errors.
None of the sources cited for this claim have been checked yet.
In the paper
“These studies use an interactive voice response tool to enhance self-care and improve the diagnosis of disease decompensation.68,69”
What the sources say
- Not checked yetcites [68] Heisler M, Piette JD. "I help you, and you help me": facilitated telephone peer support among patients with diabetes. Diabetes Educ. 2005;31:869–79. source
- Not checked yetcites [69] Heisler M, Halasyamani L, Resnicow K, et al. “I am not alone”: the feasibility and acceptability of interactive voice response-facilitated telephone peer support among older adults with heart failure. Congest Heart Fail. 2007;13:149–57. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“To improve the design of any IT-based system, the IOM proposes the application of engineering concepts and methods, especially in the area of human factors.36,37”
What the sources say
- Not checked yetcites [36] Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy Press; 1999.
- Not checked yetcites [37] Institute of Medicine of the National Academies. Patient Safety: Achieving a New Standard for Care. Washington, D.C.: National Academy Press; 2004.
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“For instance, the VA’s View Alert system tracks acknowledgement of abnormal test results, and results that go unacknowledged receive a higher degree of oversight to reduce the chance that the report would be lost in the system (e.g., Example 12).25”
What the sources say
- Not checked yetcites [25] Singh H, Arora HS, Vij MS, Rao R, Khan M, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459–66. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Customizing EMR screens to receive only critical alerts and using special alert management software to track them can avoid such problems.”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Several EMRs use a notification system (for instance, the VA’s View Alert system) that immediately alerts clinicians about clinically significant events such as abnormal test results.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This framework can inform the design and testing of IT-based interventions to improve the effectiveness of communication.”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
- Rests on an assumption: Communication breakdowns lead to diagnostic errors.
The paper relies on this without support.
EMRs can provide effective decision support, clinical reminders, and other diagnostic aids so that the diagnostic workup can be automatically prompted based on complaints and findings.
“EMRs can provide effective decision support, clinical reminders, and other diagnostic aids so that the diagnostic workup can be automatically prompted based on complaints and findings.”
The paper relies on this without support.
EMR linkages can make available a “distributed” electronic health record to several providers across multiple health care systems and thereby centralize patient information to facilitate diagnosis.
“EMR linkages can make available a “distributed” electronic health record to several providers across multiple health care systems and thereby centralize patient information to facilitate diagnosis.”
The paper relies on this without support.
Several EMRs use a notification system (for instance, the VA’s View Alert system) that immediately alerts clinicians about clinically significant events such as abnormal test results.
“Alerting for Diagnostic Test Result Management Several EMRs use a notification system (for instance, the VA’s View Alert system) that immediately alerts clinicians about clinically significant events such as abnormal test results.”
The paper relies on this without support.
Secure email can serve as an adjunct to interpersonal communication and facilitate data gathering and diagnosis verification.
“Secure email can be an adjunct to interpersonal communication and facilitates both data gathering and diagnosis verification.”
The paper relies on this without support.
EMRs can track patient appointments for tests and consultations and hence can facilitate interpersonal communication during diagnosis verification.
“EMRs can track patient appointments for tests and consultations and hence can facilitate interpersonal communication during diagnosis verification.”
The paper relies on this without support.
PHRs can be used to provide patient reminders for tests and appointments.
“PHRs can also be used to provide patient reminders for tests and appointments.”
The paper relies on this without support.
Closer monitoring of patients with increased health care needs in their homes via devices and applications connected to an electronic network can facilitate earlier diagnosis when problems arise.
“Closer monitoring of patients with increased health care needs in their homes via devices and applications connected to an electronic network can also facilitate earlier diagnosis when problems arise.”
The paper relies on this without support.
Communication breakdowns lead to diagnostic errors.
“communication breakdowns that lead to diagnostic errors”
The paper relies on this without support.
Many patient engagement processes are prone to the same errors that contribute to communication breakdowns.
“many of these processes are prone to the same errors that contribute to communication breakdowns.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“missed laboratory results or delayed recognition of results leads to a significant potential for outpatient diagnostic errors, adverse events and liability claims.”
From Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain? (2010) · cites this paper as [16]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Abstract
“Examples of communication breakdowns that may result in data gathering-related diagnostic errors 1. Interpersonal transmission errors:”
§ Abstract
“EMRs can track patient appointments for tests and consultations and hence can facilitate interpersonal communication during diagnosis verification. For instance, in Example 3 the interpersonal acknowledgement problem could be overcome using an EMR-generated reminder letter to the patient followed by a reminder notification to the physician.”
Citations
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Cited by
Sorted by citations
Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors
Bradford, A., Kunik, M. E., Schulz, P., Williams, S. P., & Singh, H. (2009) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3181a6bebc · Cited by 969
“The use of information technology, including electronic health records with integrated reminders for patient communication and follow-up, may also augment patient-provider communication and improve the diagnostic process.(22) Among providers, studies citing a lack of relevant training suggest that many primary care ph…”
BackgroundSelf-citationThe Global Burden of Diagnostic Errors in Primary Care
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017) · BMJ Quality & Safety · doi:10.1136/bmjqs-2016-005401 · Cited by 395
Self-citationMining Electronic Health Records (EHRs): A Survey
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“Multiple studies have observed that EHRs have reduced clinical errors [1–5], improved chronic illness care [6–10] and improved the completeness, accuracy and timeliness of case reporting to public health.”
Backgrounde-Health Cloud: Opportunities and Challenges
AbuKhousa, E., Mohamed, N., & Al-Jaroodi, J. (2012) · Future Internet · doi:10.3390/fi4030621 · Cited by 230
Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review
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“The volume of outpatient care and nature of high-risk transitions between health care practitioners/ providers (HCPs), settings, and systems of care makes timely communication particularly challenging.(13) For example, a patient referred for diagnostic workup for respiratory symptoms by a primary care provider (PCP) m…”
BackgroundSelf-citationPatient portals and health apps: Pitfalls, promises, and what one might learn from the other
Baldwin, J. L., Singh, H., Sittig, D. F., & Giardina, T. D. (2016) · Healthcare · doi:10.1016/j.hjdsi.2016.08.004 · Cited by 179
“For example, health IT can be used to facilitate information exchange with clinicians and instruct patients when to act upon clinical issues, such as out of range physiologic parameters, followup of test results, and complications of medication use.(2) Tools such as personal health records, patient portals, and variou…”
BackgroundSelf-citationQudah, B., & Luetsch, K. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.01.021 · Cited by 200
Reducing Hospital Errors: Interventions that Build Safety Culture
Singer, S. J., & Vogus, T. J. (2013) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031912-114439 · Cited by 219
Callen, J. L., Georgiou, A., Li, J., & Westbrook, J. I. (2011) · BMJ Quality & Safety · doi:10.1136/bmjqs.2010.044339 · Cited by 168
Singh, H., Thomas, E. J., Sittig, D. F., Wilson, L., Espadas, D., Khan, M. M., & Petersen, L. A. (2010) · The American Journal of Medicine · doi:10.1016/j.amjmed.2009.07.027 · Cited by 160
Self-citationSystem-related interventions to reduce diagnostic errors: a narrative review
Singh, H., Graber, M. L., KISSAM, S. M., Sorensen, A. V., Lenfestey, N. F., Tant, E. M., Henriksen, K., & LaBresh, K. A. (2011) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000150 · Cited by 134
Self-citationSingh, H., Hirani, K., Kadiyala, H., Rudomiotov, O., Giardina, T. D., Khan, M. M., & Wahls, T. L. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.25.6636 · Cited by 136
“so on) among front-line primary care providers, consultants, and other diagnostic specialists.(34) We hypothesized that using an EHR”
BackgroundSelf-citationQuinn, M., Forman, J. H., Harrod, M., Winter, S. M., Fowler, K. E., Krein, S. L., Gupta, A. B., Saint, S. K., Singh, H., & Chopra, V. (2018) · Diagnosis · doi:10.1515/dx-2018-0036 · Cited by 130
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Medical Malpractice Liability in the Age of Electronic Health Records
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Self-citationEight Recommendations for Policies for Communicating Abnormal Test Results
Singh, H., & Vij, M. S. (2010) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(10)36037-5 · Cited by 83
Self-citationImproving the Healthcare Effectiveness: The Possible Role of EHR, IoMT and Blockchain
Girardi, F., Gennaro, G. D., Colizzi, L., & Convertini, V. N. (2020) · Electronics · doi:10.3390/electronics9060884 · Cited by 80
“Inadequate data collection and low rates of communication lead to errors in clinical reasoning which decrease the quality of care, so it is likely that many of these errors are due to the reduced availability of the information necessary to make the correct decisions in organizing a patient’s therapeutic diagnostic pa…”
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Primary care and communication in shared cancer care: a qualitative study.
Sada, Y. H., Street, R. L., Singh, H., Shada, R. E., & Naik, A. D. (2011) · PubMed · Cited by 70
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Self-citationUsing a Multifaceted Approach to Improve the Follow-Up of Positive Fecal Occult Blood Test Results
Singh, H., Kadiyala, H., Bhagwath, G., Shethia, A., El‐Serag, H. B., Walder, A. M., Velez, M. E., & Petersen, L. A. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.55 · Cited by 63
“We believe that use of information technology and case managers with dedicated time could facilitate tracking procedures (”
Self-citationBell, S. K., Folcarelli, P. H., Fossa, A. J., Gerard, M., Harper, M. B., Leveille, S. G., Moore, C., Sands, K., Lee, B. S., Walker, J., et al. (2021) · PubMed · doi:10.1097/pts.0000000000000494 · Cited by 53
Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic Health Records
Bhise, V., Meyer, A. N. D., Singh, H., Wei, L., Russo, E. M., Al-Mutairi, A., & Murphy, D. R. (2017) · The American Journal of Medicine · doi:10.1016/j.amjmed.2017.03.009 · Cited by 56
“Unlike previous studies, which used paper-based medical records, where there is often missing diagnostic information, we used an integrated EHR, which provides comprehensive access to diagnostic information (eg, documentation of abnormal findings, reports, information about multiple provider visits) and facilitates in…”
MethodSelf-citationISBAR for clear communication: one hospital’s experience spreading the message
Finnigan, M., Marshall, S. D., & Flanagan, B. (2010) · Australian Health Review · doi:10.1071/ah09823 · Cited by 53
ICT AND THE FUTURE OF HEALTH CARE: ASPECTS OF DOCTOR-PATIENT COMMUNICATION
Haluza, D., & Jungwirth, D. (2014) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462314000294 · Cited by 49
“As a consequence, valuable communication leads to several improved physical and psychological outcomes including reduction of duplicative testing, hospital (re)admission, and mortality rates due to enhancement of patients ´ knowledge (2).”
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Communication breakdowns and diagnostic errors: a radiology perspective
Murphy, D. R., Singh, H., & Berlin, L. (2014) · Diagnosis · doi:10.1515/dx-2014-0035 · Cited by 52
“Directing solutions towards the root causes of communication breakdowns could lead to reductions in missed and delayed diagnoses and care [4].”
BackgroundSelf-citationDiagnostic errors in ambulatory care: dimensions and preventive strategies
Singh, H., & Weingart, S. N. (2009) · Advances in Health Sciences Education · doi:10.1007/s10459-009-9177-z · Cited by 51
“Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors (Singh et al. 2008).”
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“The recent voice recognition tools come with their own vulnerabilities [50], but newer information technology tools can be used to ensure a timely delivery, emphasising important information in the report with follow-ups [51] and confirming acknowledgement of receipt.”
BackgroundTeamwork Errors in Trauma Resuscitation
Sarcevic, A., Marsic, I., & Burd, R. S. (2012) · ACM Transactions on Computer-Human Interaction · doi:10.1145/2240156.2240161 · Cited by 49
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Older Adults' Needs for Home Health Care and the Potential for Human Factors Interventions
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Ten Strategies to Improve Management of Abnormal Test Result Alerts in the Electronic Health Record
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“Automated alert notification systems integrated within electronic health records (EHRs) offer a potential solution.(5,6) For instance, communication of abnormal clinical information through Balerts[ (computerized notifications of significantly abnormal or critical test results) can potentially facilitate rapid review…”
BackgroundSelf-citationChallenges for Home Health Care Providers: A Needs Assessment
McBride, S. E., Beer, J. M., Mitzner, T. L., & Rogers, W. A. (2011) · Physical & Occupational Therapy In Geriatrics · doi:10.3109/02703181.2011.552170 · Cited by 43
Missed Opportunities for the Diagnosis of Colorectal Cancer
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“Other factors contributing to diagnostic delay may include poor physician-patient communication, resulting in physician or patient failure to explore symptoms or obtain follow-up tests or referrals to specialists [16].”
BackgroundWorkarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care
Menon, S., Murphy, D. R., Singh, H., Meyer, A. N. D., & Sittig, D. F. (2016) · Applied Clinical Informatics · doi:10.4338/aci-2015-10-ra-0135 · Cited by 40
“Electronic health records (EHRs) facilitate reliable communication of test results to clinicians [1].”
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“18,19 EHRs may indeed reduce some barriers to care coordination and decision making among providers, but their simple implementation within health care systems is unlikely to reduce all disin-centives to ineffective communication and may themselves contribute novel sources of system-related errors.”
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Improving outpatient safety through effective electronic communication: a study protocol
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“Health IT and EMRs are perhaps one of the most powerful systems-based interventions to facilitate the diagnostic process because they ensure the delivery of key findings and other health-related information to the practitioner [11].”
Self-citationSubbe, C. P., Tellier, G., & Barach, P. R. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-047446 · Cited by 36
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Powell, L., Sittig, D. F., Chrouser, K. L., & Singh, H. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.6752 · Cited by 34
Self-citationDiagnostic errors: moving beyond ‘no respect’ and getting ready for prime time
Singh, H. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-002387 · Cited by 32
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The Rate of Missed Test Results in an Emergency Department
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“The strategy of transmission of results by more than one method has been suggested as a way of reducing missed results [32].”
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“In order to address this in a multifaceted sociotechnical context, we intended the functional prototype design to meet the following goals, many of which were conceived based on previous research findings: [1, 3, 4, 27–29, 33–37] 1.”
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Releasing test results directly to patients: A multisite survey of physician perspectives
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“Although electronic health records are increasingly used to facilitate notification of abnormal test results to physicians [11], follow-up failures continue to occur [2,12].”
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Cancer communication and informatics research across the cancer continuum.
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Rights and responsibilities of users of electronic health records
Sittig, D. F., & Singh, H. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111599 · Cited by 30
“Comprehensive, well-implemented electronic health records with advanced clinical decision support interventions have potential to reduce errors with medications(8) and to increase the quality, efficiency and reliability of information transfer.(9,10)”
BackgroundSelf-citationProvision of mental health care services to deaf individuals using telehealth.
Wilson, J. A. B., & Schild, S. (2014) · Professional Psychology Research and Practice · doi:10.1037/a0036811 · Cited by 23
Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment
Rahman, M. M., Mim, S. A., Islam, M. R., Parvez, A., Islam, F., Uddin, M. B., Rahaman, M. S., Shuvo, P. A., Ahmed, M., Greig, N. H., et al. (2022) · Current Medicinal Chemistry · doi:10.2174/0929867329666220408102051 · Cited by 23
Assigning responsibility to close the loop on radiology test results
Kwan, J. L., & Singh, H. (2017) · Diagnosis · doi:10.1515/dx-2017-0019 · Cited by 23
“Closed-loop communication includes not just a one-way transfer of information from sender to recipient, but also the acknowledgment of receipt by the recipient, and importantly in the case of test result communication, follow-up action on the test result [8].”
Self-citationMaintaining IoT Healthcare Records Using Cloud Storage
Chennam, K. K., Maheswari, V. U., & Aluvalu, R. (2021) · EAI/Springer Innovations in Communication and Computing · doi:10.1007/978-3-030-82715-1_10 · Cited by 21
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An adverse event capture and management system for cancer studies
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“When addressing new AEs, AERS will not allow the clinician to select an AE that is currently ongoing whether it was previously documented as a symptom or a diagnosis to eliminate duplicate reporting [10,11].”
BackgroundRecommendations From the Twitter Hashtag #DoctorsAreDickheads: Qualitative Analysis
Sharma, A. E., Mann, Z., Cherian, R., Rosario, J. B. D., Yang, J., & Sarkar, U. (2020) · Journal of Medical Internet Research · doi:10.2196/17595 · Cited by 18
“Improvements are urgently needed in how clinicians communicate and how patients are involved in the diagnostic pathway [24,25].”
BackgroundElectronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism
Meyer, A. N. D., Murphy, D. R., Al-Mutairi, A., Sittig, D. F., Wei, L., Russo, E. M., & Singh, H. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-3988-z · Cited by 14
Self-citationHerasevich, S., Soleimani, J., Huang, C., Pinevich, Y., Dong, Y., Pickering, B. W., Murad, M. H., & Barwise, A. K. (2023) · BMJ Quality & Safety · doi:10.1136/bmjqs-2022-015038 · Cited by 20
Do not assume that no news is good news: test result management and communication in primary care
Kwan, J. L., & Cram, P. M. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004645 · Cited by 16
“However, these IT solutions have generated mixed results 10 – 12 and seem unlikely to deliver the silver bullet they were once touted to be.”
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Harvey, H. B., Alkasab, T. K., Pandharipande, P. V., Zhao, J., Halpern, E. F., Salazar, G., Abujudeh, H. H., Rosenthal, D. I., & Gazelle, G. S. (2014) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2014.08.013 · Cited by 16
“Failures of communication in these instances can result in preventable patient morbidity and mortality and associated legal liability [1-7].”
BackgroundClinical Dental Faculty Members’ Perceptions of Diagnostic Errors and How to Avoid Them
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Dunn, A. G., Ong, M., Westbrook, J. I., Magrabi, F., Coiera, E. W., & Wobcke, W. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000075 · Cited by 16
“This particular process reflects a well-defined workflow with numerous checkpoints and redundant operations that are included with the aim of minimizing the potential for risk. Yet despite this, the potential for risk, either risk not mitigated by the process (in the misidentification scenario) or the risk generated b…”
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Anti-MDA5-Positive Dermatomyositis Presenting as Fever of Unknown Origin
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A Concept Analysis of Organizational Health and Communication
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Curbing Inappropriate Usage of STAT Imaging at a Large Academic Medical Center
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Metadata
- Authors
- Singh, H., Naik, A. D., Rao, R., & Petersen, L. A.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Baylor College of Medicine (US)
- Corresponding author
- Singh, Hardeep
- Venue
- Journal of General Internal Medicine
- Published
- 2008-03-29
- Volume
- 23
- Issue
- 4
- Pages
- 489-494
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2359508
- OpenAlex
- W2086374949
- Semantic Scholar
- 17711845dc04a672bc6ed5878097ed52537953ab
- Cited by
- 162
- References
- 76
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 3 · 2023: 8 · 2022: 2 · 2021: 9 · 2020: 8 · 2019: 6 · 2018: 13 · 2017: 9 · 2016: 9 · 2015: 17 · 2014: 10 · 2013: 7 · 2012: 10
- FWCI
- 8.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality
- National Institute on Aging (K23AG027144)
- National Cancer Institute (K23CA125585)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- diagnostic errors, communication breakdown, diagnostic error prevention, medical errors, patient involvement, medical records management, diagnostic process
- MeSH terms
- Diagnostic Errors, Hospital Information Systems, Humans, Interprofessional Relations, Medical Records Systems, Computerized, Biomedical Technology
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
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