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Cited by 131Clinical Reasoning and Diagnostic SkillsElectronic Health Records SystemsMedical Coding and Health Information

Electronic Health Record-Based Surveillance of Diagnostic Errors in Primary Care

Open access
Singh, Hardeep, Giardina, Traber Davis, Forjuoh, Samuel N, Reis, Michael D, Kosmach, Steven, Khan, Myrna M, Thomas, Eric J·2012·BMJ Quality & Safety
DOI 10.1136/bmjqs-2011-000304PMC PMC3680372
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Abstract

Background: Diagnostic errors in primary care are harmful but difficult to detect. The authors tested an electronic health record (EHR)-based method to detect diagnostic errors in routine primary care practice. Methods: The authors conducted a retrospective study of primary care visit records ‘triggered’ through electronic queries for possible evidence of diagnostic errors: Trigger 1: A primary care index visit followed by unplanned hospitalisation within 14 days and Trigger 2: A primary care index visit followed by ≥1 unscheduled visit(s) within 14 days. Control visits met neither criterion. Electronic trigger queries were applied to EHR repositories at two large healthcare systems between 1 October 2006 and 30 September 2007. Blinded physician–reviewers independently determined presence or absence of diagnostic errors in selected triggered and control visits. An error was defined as a missed opportunity to make or pursue the correct diagnosis when adequate data were available at the index visit. Disagreements were resolved by an independent third reviewer. Results: Queries were applied to 212 165 visits. On record review, the authors found diagnostic errors in 141 of 674 Trigger 1-positive records (positive predictive value (PPV)=20.9%, 95% CI 17.9% to 24.0%) and 36 of 669 Trigger 2-positive records (PPV=5.4%, 95% CI 3.7% to 7.1%). The control PPV of 2.1% (95% CI 0.1% to 3.3%) was significantly lower than that of both triggers (p≤0.002). Inter-reviewer reliability was modest, though higher than in comparable previous studies (к=0.37 (95% CI 0.31 to 0.44)). Conclusions: While physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors.

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  • Diagnostic error research has primarily focused on capturing disease-related factors, including laboratory results, imaging, and treatments, which are easier to extract from medical records.

    “Diagnostic error research has primarily focused on capturing disease-related factors [18,19,20,21], including laboratory results, imaging, and treatments, which are easier to extract from medical records.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [18]

    The Background and Discussion passages describe diagnostic errors as understudied and compare methods for detecting them; they do not say research has primarily focused on disease-related factors. The Methods mention chest X-rays as diagnostic evidence, but neither those passages nor further searches for laboratory results, imaging, treatments, and extraction from records establish the claimed research focus or explain that those factors are easier to extract. Page numbers were not available in our copy. (LLM, conf=0.72)

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1 of the 52 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [48]Zwaan L de Bruijne M Wagner C Patient Record Review of the Incidence, Consequences, and Causes of Diagnostic Adverse Events Arch Intern Med 2010 6 15 170 12 1015 21 20585065

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Authors
Singh, H., Giardina, T. D., Forjuoh, S. N., Reis, M. D., Kosmach, S., Khan, M. M., & Thomas, E. J.
Affiliations
  • Michael E. DeBakey VA Medical Center (US)
  • Texas A&M Health Science Center (US)
  • The University of Texas Health Science Center at Houston (US)
  • Memorial Hermann (US)
Corresponding author
Singh, Hardeep
ORCID
Venue
BMJ Quality & Safety
Publisher
BMJ
Published
2011-10-13
Volume
21
Issue
2
Pages
93-100
ISSN
  • 1475-3898 (ISSN-L)
  • 2044-5415
  • 2044-5423
DOI
10.1136/bmjqs-2011-000304
PMC
PMC3680372
OpenAlex
W2169041559
Cited by
131
References
52
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 20 · 2022: 10 · 2021: 11 · 2020: 6 · 2019: 7 · 2018: 12 · 2017: 10 · 2016: 6 · 2015: 16 · 2014: 14 · 2013: 5
FWCI
5.89
Type
journal article
Language
en
Open access
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • National Institutes of Health (HFP90-020)
  • Agency for Healthcare Research and Quality (R18 HS17244-02, R18HS017244)
  • National Cancer Institute (K23CA125585)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Keywords
diagnostic errors, electronic health records, primary care, emergency admissions, unscheduled visits, positive predictive value, missed diagnosis
MeSH terms
Diagnostic Errors, Humans, Medical Audit, Primary Health Care, Retrospective Studies, Texas, Electronic Health Records

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