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.
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“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]
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Cites
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Self-citationDiagnostic error in internal medicine
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Self-citationComputerized Surveillance of Adverse Drug Events in Hospital Patients
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Singh, H., Meyer, A. N. D., & Thomas, E. J. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-002627 · Cited by 677
Self-citationThe incidence of diagnostic error in medicine
Graber, M. L. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001615 · Cited by 626
Types and Origins of Diagnostic Errors in Primary Care Settings
Singh, H., Giardina, T. D., Meyer, A. N. D., Forjuoh, S. N., Reis, M. D., & Thomas, E. J. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.2777 · Cited by 559
Self-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-citationNewman‐Toker, D. E., Moy, E. M., Valente, E., Coffey, R. M., & Hines, A. L. (2014) · Diagnosis · doi:10.1515/dx-2013-0038 · Cited by 263
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
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