The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index.
Electronic health record-based surveillance of diagnostic errors in primary care
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Hindsight is not equal to foresight: The effect of outcome knowledge on judgment under uncertainty.
Fischhoff, B. (1975) · Journal of Experimental Psychology Human Perception & Performance · doi:10.1037/0096-1523.1.3.288 · Cited by 1,970
Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado
Thomas, E. J., Studdert, D. M., Burstin, H. R., Orav, E. J., Zeena, T., WILLIAMS, E. J., Howard, K., Weiler, P. C., & Brennan, T. A. (2000) · Medical Care · doi:10.1097/00005650-200003000-00003 · Cited by 1,673
Self-citationDiagnostic error in internal medicine
Graber, M. L., Franklin, N., & Gordon, R. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.13.1493 · Cited by 1,549
Classen, D. C., Resar, R., Griffin, F., Federico, F., Frankel, T., Kimmel, N., Whittington, J. C., Frankel, A., Seger, A., & James, B. C. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0190 · Cited by 1,027
Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims
Gandhi, T. K., Kachalia, A., Thomas, E. J., Puopolo, A. L., Yoon, C., Brennan, T. A., & Studdert, D. M. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-7-200610030-00006 · Cited by 662
Self-citationComputerized Surveillance of Adverse Drug Events in Hospital Patients
Classen, D. C. (1991) · JAMA · doi:10.1001/jama.1991.03470200059035 · Cited by 643
Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors
Schiff, G. D. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.333 · Cited by 638
Jha, A. K., Kuperman, G. J., Teich, J. M., Leape, L. L., Shea, B. S., Rittenberg, E., Burdick, E., Seger, D. L., Vliet, M. V., & Bates, D. W. (1998) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1998.0050305 · Cited by 514
Detecting Adverse Events Using Information Technology
Bates, D. W., Evans, R. S., Murff, H. J., Stetson, P. D., Pizziferri, L., & Hripcsak, G. M. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1074 · Cited by 467
Measuring errors and adverse events in health care
Thomas, E. J., & Petersen, L. A. (2003) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2003.20147.x · Cited by 456
Self-citation
Cited by
Sorted by citations
Items 101–130 of 130
Mull, H. J., Rosen, A. K., Shimada, S. L., Rivard, P. E., Nordberg, B., Long, B., Hoffman, J. M., Leecaster, M. K., Savitz, L. A., Shanahan, C. W., et al. (2015) · eGEMs (Generating Evidence & Methods to improve patient outcomes) · doi:10.13063/2327-9214.1116 · Cited by 4
Diagnostic errors in patients admitted directly from new outpatient visits
Watanabe, Y., Miyagami, T., Shimizu, T., Nishizaki, Y., Ukishima, S., Santo, K., Kushiro, S., Aoki, N., Suzuki, M., Kanazawa, A., et al. (2024) · Diagnosis · doi:10.1515/dx-2024-0088 · Cited by 4
Sumner, W., Stwalley, D. L., Asaro, P. V., Hagen, M. D., & Olsen, M. A. A. (2014) · PubMed Central · Cited by 4
Measuring Diagnostic Safety of Inpatients: Time to Set Sail in Uncharted Waters
Bhise, V., & Singh, H. (2015) · Diagnosis · doi:10.1515/dx-2015-0003 · Cited by 3
Self-citationIsolating red flags to enhance diagnosis (I-RED): An experimental vignette study
Chartan, C. A., Singh, H., Krishnamurthy, P., Sur, M., Meyer, A. N. D., Lutfi, R., Stark, J. E., & Thammasitboon, S. (2019) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzz082 · Cited by 3
Self-citationAutomated identification of diagnostic labelling errors in medicine
Hautz, W. E., Kündig, M. M., Tschanz, R., Birrenbach, T., Schuster, A., Bürkle, T., Hautz, S. C., Sauter, T. C., & Krummrey, G. (2021) · Diagnosis · doi:10.1515/dx-2021-0039 · Cited by 3
Alanazi, A., Almutib, A., & Aldosari, B. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13040680 · Cited by 3
Michelson, K. A., Bachur, R. G., Cruz, A. T., Grubenhoff, J. A., Reeves, S. D., Chaudhari, P. P., Monuteaux, M. C., Dart, A. H., & Finkelstein, J. A. (2023) · Diagnosis · doi:10.1515/dx-2023-0019 · Cited by 3
Garzón, G., Alonso‐Safont, T., Míquel, D. C., Jurado, M. C., Aguado-Arroyo, Ó., Balbuena, J. J. J., Sanz, C. V., Fraile, E. Z., Gayán, A. L., Dorado, A. C., et al. (2023) · Journal of Patient Safety · doi:10.1097/pts.0000000000001161 · Cited by 3
Brown, B. C., Williams, R., Sperrin, M., Frank, T. L., Ainsworth, J. D., & Buchan, I. E. (2014) · PubMed Central · Cited by 3
Hassoon, A., Ng, C., Lehmann, H. P., Rupani, H., Peterson, S., Horberg, M. A., Liberman, A. L., Sharp, A. L., Johansen, M. C., McDonald, K., et al. (2024) · Diagnosis · doi:10.1515/dx-2023-0138 · Cited by 2
Enayati, M., Khalili, M., Patel, S., Huschka, T. R., Cabrera, D., Parker, S. J., Pasupathy, K. S., Mahajan, P., & Bellolio, F. (2025) · Journal of Patient Safety · doi:10.1097/pts.0000000000001409 · Cited by 2
Diagnostic Errors in Hospitalized Patients
Goyal, A. (2023) · Journal of clinical outcomes management · doi:10.12788/jcom.0121 · Cited by 2
A Machine-Learning-Based Approach for Identifying Diagnostic Errors in Electronic Medical Records
Zhao, B., Zhang, R., Chen, D., Bai, K., Zhao, H., Gong, S., & Zhu, X. (2023) · IEEE Transactions on Reliability · doi:10.1109/tr.2023.3330733 · Cited by 2
The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
Kanter, M. H., Ghobadi, A., Lurvey, L. D., Liang, S., & Litman, K. C. (2022) · Diagnosis · doi:10.1515/dx-2022-0083 · Cited by 2
Kamiya, S., Nishizawa, T., Ozawa, H., Harada, Y., Watari, T., Shimizu, T., Sakurai, M., Suzuki, Y., Deshpande, G. A., & Arioka, H. (2025) · Diagnosis · doi:10.1515/dx-2024-0197 · Cited by 1
Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients
Pinevich, Y., Barwise, A. K., Austin, J. M., Soleimani, J., Herasevich, S., Redmond, S. A., Dong, Y., Herasevich, V., Gajic, O., & Pickering, B. W. (2023) · Biomolecules and Biomedicine · doi:10.17305/bb.2022.8393 · Cited by 2
Cohen, A., Thammasitboon, S., Singhal, G., & Epner, P. L. (2023) · Springer eBooks · doi:10.1007/978-3-031-35933-0_15 · Cited by 1
Miller, A. C., Cavanaugh, J. E., Arakkal, A. T., Koeneman, S., & Polgreen, P. M. (2021) · medRxiv · doi:10.1101/2021.10.22.21265386 · Cited by 1
Complementary Approaches to Identifying Missed Diagnostic Opportunities in Hospitalized Children
Grubenhoff, J. A., & Perry, M. F. (2023) · Hospital Pediatrics · doi:10.1542/hpeds.2023-007249 · Cited by 1
Franke, A. D., & Sehly, A. A. (2023) · doi:10.36227/techrxiv.24748251.v1 · Cited by 1
[Incompetence of the anal sphincter].
Op, G., & Gn, K. (1989) · PubMed
What’s the harm in waiting? Patient harms in the referral waiting gap
Patel, V. (2016) · Otago University Research Archive (University of Otago)
Black, G. B., Bhuiya, A., Smith, C. F., Hirst, Y., & Nicholson, B. D. (2021) · doi:10.2196/preprints.35726
16. Diagnostic Support from Information Technology
(2017) · CRC Press eBooks · doi:10.1201/9781315116334-22
Strategies to Avoid a Misdiagnosis
Tohid, H. (2023) · Springer eBooks · doi:10.1007/978-3-031-28296-6_70
Franke, A. D., & Sehly, A. A. (2023) · doi:10.36227/techrxiv.24748251
Propiedades psicométricas del Cuestionario de Cultura de Seguridad del Paciente en Atención Primaria
Cuadros-Carlesi, K., Leal-Kaymalyz, C. G., Santiagos-Mercado, C., & Zúñiga-Abarzúa, W. (2025) · Revista Ciencias de la Salud · doi:10.12804/revistas.urosario.edu.co/revsalud/a.13700
Understanding Medical Diagnostic Error Using Reliability and Maintainability Engineering
Franke, A. D., & Sehly, A. A. (2026) · Annual Reliability and Maintainability Symposium (RAMS) · doi:10.1109/rams50514.2026.11424462
Metadata
- 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
- 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
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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
