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

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Electronic health record-based surveillance of diagnostic errors in primary care

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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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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: Singh, Hardeep
Giardina, Traber Davis
Forjuoh, Samuel N
Reis, Michael D
Khan, Myrna M
Thomas, Eric J
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: bronze
doi.org
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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