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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.
- 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.
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.
- 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.
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.
- 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.
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.
- 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
“This framework posits that many diagnostic errors can be traced to 1 or more communication errors during data gathering and diagnosis verification.”
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: unclear — It is unclear why the paper says it holds.
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
hedgeddirect- 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, an acknowledgement breakdown can still lead to a poor outcome because the sender may not be able to verify whether the message was received and the action took place.”
hedgeddirect- 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
“Inadequate data collection would lead to errors in clinical reasoning and therefore in data integration as well.”
hedgeddirect- 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.
In the paper
“In another study, 68% of specialists reported not receiving any information from the primary care physician before the referral visit, and 25% of primary care physicians reported that they still had not received any information from specialists 4 weeks after referral visits.28”
What the sources say
- 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
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.
In the paper
“Despite the importance of diagnostic errors, relatively little is known about their causes and prevention.22”
What the sources say
- Not checked yetcites [22] Singh H, Petersen LA, Thomas EJ. Understanding diagnostic errors in medicine: a lesson from aviation. Qual Saf Health Care. 2006;15:159–64. 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.
None of the sources cited for this claim have been checked yet.
In the paper
“For instance, computerized information systems themselves can lead to unintended errors including those that involve communication processes.25,34,42”
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
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.
In the paper
“In our recent work on informational communication related to diagnosis verification, we have validated a 3-point taxonomy of communication breakdowns proposed by Weinger in which communication errors are classified as breakdowns in message transmission, message reception, and message acknowledgement.35”
What the sources say
- Not checked yetcites [35] Weinger MB, Blike G. Intubation Mishap. Agency for Health Care Research and Quality Web M & M Rounds. 2003.
boosted- 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.
In the paper
“In another study, 68% of specialists reported not receiving any information from the primary care physician before the referral visit, and 25% of primary care physicians reported that they still had not received any information from specialists 4 weeks after referral visits.28”
What the sources say
- 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
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.
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 a refined cognitive theory of diagnostic decision making will require years of development, in the near term communication processes are a more feasible target for improving the timeliness and accuracy of diagnoses.”
plainconditional- 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.
In the paper
“Although direct reporting to patients may prevent loss of follow-up, physicians currently tend to favor direct reporting only when test results are normal, have less diagnostic severity, or have less potential for emotional impact.55”
What the sources say
- Not checked yetcites [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
plaincorrelational- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“Electronic “alerts” have been shown to improve critical lab results communication in the inpatient setting, and they show promise in improving the safety of outpatient test result follow-up.45,52,53”
What the sources say
- Not checked yetcites [45] Kuperman GJ, Teich JM, Tanasijevic MJ, et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc. 1999;6:512–22. source
- Not checked yetcites [52] Rind DM, Safran C, Phillips RS, et al. Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med. 1994;154:1511–7. source
- Not checked yetcites [53] Choksi V, Marn C, Piotrowski M, Bell Y, Carlos R. Illustrating the root cause analysis process: creation of safety net with a semi-automated process for notification of critical findings in diagnostic imaging. J Am Coll Radiol. 2005;2:768–76. source
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.
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
“Electronic alerting could help prevent the communication breakdown in Example 10, where the abnormal report would be sent to the provider’s EMR screen automatically.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“adoption by physicians is generally low61–63”
What the sources say
- Not checked yetcites [61] Baker LP, Wagner THP, Singer SM, Bundorf MK. Use of the internet and e-mail for health care information: results from a national survey. (Article). JAMA. 2003;289:2400–6. source
- Not checked yetcites [62] Brooks GR, Menachemi N. Physicians’ use of email with patients: factors influencing electronic communication and adherence to best practices. J Med Internet Res. 2006;8:e2. source
- Not checked yetcites [63] Moyer CA, Stern DT, Dobias KS, Cox DT, Katz SJ. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Manag Care. 2002;8:427–33.
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.
In the paper
“Although overall patient desire to communicate with their physicians electronically is high,60”
What the sources say
- Not checked yetcites [60] Sittig DF, King S, Hazlehurst BL. A survey of patient–provider e-mail communication: what do patients think? International Journal of Medical Informatics. 2001;61:71–80. source
plain- 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.
In the paper
“Clearly, the training curriculum needs to further emphasize traditional history and physical examination to our future physicians, who tend to over-rely on expensive and unnecessary diagnostic tests.48”
What the sources say
- Not checked yetcites [48] Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med. 1999;74:S138–43. source
boosted- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“Electronic “alerts” have been shown to improve critical lab results communication in the inpatient setting, and they show promise in improving the safety of outpatient test result follow-up.45,52,53”
What the sources say
- Not checked yetcites [45] Kuperman GJ, Teich JM, Tanasijevic MJ, et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc. 1999;6:512–22. source
- Not checked yetcites [52] Rind DM, Safran C, Phillips RS, et al. Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med. 1994;154:1511–7. source
- Not checked yetcites [53] Choksi V, Marn C, Piotrowski M, Bell Y, Carlos R. Illustrating the root cause analysis process: creation of safety net with a semi-automated process for notification of critical findings in diagnostic imaging. J Am Coll Radiol. 2005;2:768–76. source
hedgedconditional- 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.
In the paper
“Studies including our own have reported communication breakdowns among providers even in systems that use advanced IT.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
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.
In the paper
“In addition, “smart monitors” could reduce the total number of alerts by filtering information through algorithms so that providers are alerted only when immediate action is necessary.54”
What the sources say
- Not checked yetcites [54] Wahls T, Haugen T, Cowell K, Becker B. Assessing diagnostic test result managment in a VA health care network. Fed Pract. 2006;23:23–42.
hedgedconditional- 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.
In the paper
“Email also has potential to enhance patient–physician interaction, particularly when face-to-face communication is limited,57”
What the sources say
- Not checked yetcites [57] Weiner M, Biondich P. The influence of information technology on patient–physician relationships. J Gen Intern Med. 2006;21(Suppl 1):S35–9. source
hedgedconditional- 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.
In the paper
“An EMR can reduce the problem of missing clinical information that is frequently encountered in paper-based records.49”
What the sources say
- Not checked yetcites [49] Smith PC, Raya-Guerra R, Bublitz C, et al. Missing clinical information during primary care visits. JAMA. 2005;293:565–71. source
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.
In the paper
“and several barriers exist.64”
What the sources say
- Not checked yetcites [64] Slack WV. A 67-year-old man who e-mails his physician. JAMA. 2004;292:2255–61. source
plain- 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.
In the paper
“Data gathering problems may be the most common reasons for diagnostic errors, at least among trainees.4”
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
hedgedconditional- 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
“Provider-to-provider communication through electronic progress notes could reduce communication breakdowns between health providers as in Examples 4 and 5.”
hedgedconditional- 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: unclear — It is unclear why the paper says it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Thus, achieving high standards of patient safety through the use of IT also entails system redesign to include formal policies and procedures regarding the use of IT.43–47”
What the sources say
- Not checked yetcites [43] Brantley SD, Brantley RD. Reporting significant unexpected findings: the emergence of information technology solutions. J Am Coll Radiol. 2005;2:304–7. source
- Not checked yetcites [44] Brenner RJ. To err is human, to correct divine: the emergence of technology-based communication systems. J Am Coll Radiol. 2006;3:340–5. source
- Not checked yetcites [45] Kuperman GJ, Teich JM, Tanasijevic MJ, et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc. 1999;6:512–22. source
- Not checked yetcites [46] Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003;36:80–91. source
- Not checked yetcites [47] Berlin L. Using an automated coding and review process to communicate critical radiologic findings: one way to skin a cat. AJR Am J Roentgenol. 2005;185:840–3. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could 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. 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.
- 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.
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.
- 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.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- 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.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- 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. 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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- 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.
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.
- 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.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
- 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.
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.
- 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
“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.
- 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.
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.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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
Cites
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The Framing of Decisions and the Psychology of Choice
Tversky, A., & Kahneman, D. (1981) · Science · doi:10.1126/science.7455683 · Cited by 18,497
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To Err is Human: Building a Safer Health System
Hendee, W. R. (2001) · Journal of Vascular and Interventional Radiology · doi:10.1016/s1051-0443(01)70072-3 · Cited by 10,129
Judgment under Uncertainty: Heuristics and Biases
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Wall, A. (2000) · British Journal of Healthcare Management · doi:10.12968/bjhc.2000.6.9.19311 · Cited by 5,912
Judgment Under Uncertainty: Heuristics and Biases.
Shafer, G. R., Kahnerman, D., Slovic, P., & Tversky, A. (1984) · Journal of the American Statistical Association · doi:10.2307/2288362 · Cited by 5,658
Judgment under uncertainty: Causality and attribution
Kahneman, D. J., Slovic, P., & Tversky, A. (1982) · Cited by 4,670
Judgment under uncertainty: List of contributors
Kahneman, D. J., Slovic, P., & Tversky, A. (1982) · Cited by 4,670
Sources of Power: How People Make Decisions
Klein, G. A., & Sullivan, J. P. (2001) · Leadership and Management in Engineering · doi:10.1061/(asce)1532-6748(2001)1:1(21 · Cited by 2,159
Research works printed but not linked: 3
- Sox HC, Blatt MA, Higgins MC, Marton KI. Medical Decision Making. Stoneham, MA: Butterworth-Heinemann; 1988.
- Institute of Medicine of the National Academies. Patient Safety: Achieving a New Standard for Care. Washington, D.C.: National Academy Press; 2004.
- Wahls T, Haugen T, Cowell K, Becker B. Assessing diagnostic test result managment in a VA health care network. Fed Pract. 2006;23:23–42.
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
Yadav, P., Steinbach, M., Kumar, V., & Simon, G. (2018) · ACM Computing Surveys · doi:10.1145/3127881 · Cited by 299
“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
Callen, J. L., Westbrook, J. I., Georgiou, A., & Li, J. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1949-5 · Cited by 229
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.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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