By Stacey Kusterbeck
Many, if not most, emergency care providers would agree there are some significant downsides to electronic health records (EHRs), including usability, interoperability, and malfunctions, to name a few. But are these issues merely annoying, or do they actually contribute to diagnostic errors? A group of researchers set out to answer this question by analyzing 199 closed claims from 2015 to 2021.1
“A clinician’s ability to access clinical information, and the format in which it is presented, is crucial to optimizing the diagnostic process,” notes Raj Ratwani, MA, PhD, one of the study authors and director of the MedStar National Center for Human Factors Engineering in Healthcare in Washington, DC.
The ubiquitous EHRs has become the primary repository for clinical information. Ratwani and colleagues sought to understand how aspects of the EHR might influence diagnostic errors by reviewing closed legal claims data from ambulatory settings.
Many diagnostic-related claims with a noted EHR factor described the system as a potential contributor to the diagnosis-related error. More than 90% of these issues were related to testing — timely ordering of appropriate tests, performing tests correctly, or clinician processing of test results. More than 70% of the EHR-related problems resulted in delayed or missed diagnoses rather than incorrect diagnoses. “There are several important considerations for emergency medicine,” Ratwani says.
Ratwani offers these two specific actions for ED leaders to take to prevent EHR-related diagnostic errors:
• Pay attention to testing. This is important, considering most diagnostic-related EHR claims were associated with testing. “Testing is a critical component for emergency medicine,” Ratwani notes.
For example, EDs should identify ways to ensure closed-loop communication of test results. Leaders also should enable rapid access to past patient information.
• Assess EHRs for possible usability and design problems. Ideally, says Ratwani, health systems should address these issues when implementing their EHR platform. Unfortunately, some design flaws cannot be addressed before the system is implemented. Instead, providers have to be aware of the shortcomings, and make practice changes accordingly.
“EDs can train clinicians to be aware of, and proactively identify, potential EHR-based shortcomings that could contribute to diagnostic errors,” Ratwani suggests.
For example, a patient’s historical lab values might not be immediately available on one screen in the EHR. This could contribute to diagnostic error because the emergency clinician does not have appropriate context to compare current values with prior results. If emergency clinicians recognize this design issue, they know it is necessary to take the time to find the relevant lab values by searching through the record. “This information could provide important contextual information that may improve the diagnostic process,” Ratwani says.
REFERENCE
1. Krevat SA, Samuel S, Boxley C, et al. Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis. JAMA Netw Open 2023;6:e238399.
Many, if not most, emergency care providers would agree there are some significant downsides to electronic health records, including usability, interoperability, and malfunctions, to name a few. But are these issues merely annoying, or do they actually contribute to diagnostic errors?
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