Study Finds EHR Issues Can Contribute to Ambulatory Diagnostic Errors

EHR issues such as suboptimal design or clinician use can contribute to diagnostic errors in ambulatory settings, according to a study published in JAMA Network Open.

The study analyzed legal claims in ambulatory settings with a loss year between 1987 and 2020 that were closed between January 2015 and September 2021.

The researchers retrieved claims from the CRICO malpractice insurance database, representing more than 550 inpatient and outpatient healthcare facilities. 

Using a proprietary taxonomy defining the allegation type and contributing factors, the researchers coded 238 claims as diagnosis-related with an EHR contributing factor.

Then, two physicians reviewed each claim summary to determine the presence of a diagnostic error, the stage of the diagnostic process in which the error occurred, the type of error, and the outcome of the error. A third physician reviewed the claim if the physicians could not reach a consensus.

The study defined the presence of a diagnostic error as inaccurately determining which disease or condition explains a patient's signs or symptoms.

The physicians confirmed 199 claims as diagnosis-related. Of those 199 claims, the EHR was considered a potential contributor to the diagnostic error in 122 claims (61.3 percent). The most common error types were related to execution (50.8 percent), ordering (45.9 percent), and data interpretation (45.9 percent).

The outcomes of the 122 diagnosis-related claims with an EHR contributing factor included 87 missed or delayed diagnoses, 33 wrong diagnoses, and two claims with unclear effects.

"The findings of this qualitative study illustrate the central role of the EHR for supporting the diagnostic process and the potential for EHR issues such as suboptimal design or clinician use to facilitate diagnostic errors," the study authors wrote.

"These results highlight the importance of the continued work needed to optimize EHR design, interoperability, training, and safety surveillance to reduce diagnostic errors," the authors emphasized.

They suggested that more granular reporting taxonomies are needed to understand the specific EHR issues potentially contributing to diagnostic errors.

The researchers noted that their study has limitations.

"The reliance on the claim summary for review, as opposed to the entire legal medical record, limits our findings," they acknowledged.

The study authors also noted that any issues that did not result in a claim are not part of the analysis. Further, the research does not account for EHR adoption and optimizations over time.