More EHR research needed to prevent diagnostic errors

Diagnostic errors can trigger unplanned hospitalizations, return visits or ER visits and put patients at greater health risk. More reviews of EHRs could help providers address the breakdowns causing missed, delayed or wrong diagnoses, according to a JAMA Internal Medicine study published on Feb. 25.

Hardeep Singh, MD and his colleagues reached these findings while looking into the causes of 190 diagnostic errors detected in primary care visits at a large Veterans Affairs facility and integrated private healthcare system from Oct. 1, 2006 to Sept. 30, 2007. The most common missed diagnoses included pneumonia (6.7 percent), decompensated congestive heart failure (5.7 percent), cancer (primary) (5.3 percent), and urinary tract infection/pyelonephritis (4.8 percent).

Breakdowns occurring during the patient-practitioner clinical encounter account for the majority of these errors, and relate to problems with history taking, examination and ordering diagnostic tests for further workup. “Most errors were associated with potential for moderate to severe harm,” the authors stated.

The development of preventative interventions should target common contributory factors across diagnoses and should involve data gathering and synthesis during the patient-practitioner, according to the report.

While diagnostic errors are inevitable as primary care physicians encounter increasingly complex and severe conditions, more research could help reduce their frequency. “[D]ata about the most frequent misdiagnosed conditions are scarce, and little is known about which diagnostic processes are most vulnerable to breakdown,” the report found, noting that most data on diagnostic errors are derived from less-reliable sources such as malpractice claims and self-report surveys.

Greater use of EHRs to determine causes of diagnostic errors “could advance knowledge about conditions that are vulnerable to being missed in primary case and help prioritize diagnostic errors in primary care settings,” Singh and his colleagues concluded.