Tool Helps Patients Identify Diagnostic Concerns in EHR Notes

Patients can identify diagnostic safety concerns based on a proactive structured evaluation of EHR notes, according to a study published in JAMIA.

Researchers adapted an EHR review tool to enable patients potentially vulnerable to diagnostic errors to review their visit notes, identify breakdowns in the diagnostic process, and self-report any diagnostic problems.

While this article focused on patient evaluations of the diagnostic process rather than the diagnostic process from a provider perspective, the study authors said that patient perceptions are influential predictors of trust in the medical system.

“Systematic evaluation of visit notes by patients has potential to uncover underlying patient-centered contributory factors that affect diagnosis, which is otherwise harder to gather,” the researchers wrote.

“With additional development and testing, this strategy could be used in the future as part of larger organizational initiatives to identify and learn from patient-reported diagnostic concerns and promote organizational learning,” they added.

For example, the EHR review tool could provide near real-time data to healthcare organizations about patients’ experiences of the diagnostic process to address care quality issues.

Feedback from patients could also be helpful to clinicians and healthcare organizations to improve practice and potentially improve diagnostic performance. 

“Such feedback programs are essential for the development of a learning health system to improve patient safety,” the researchers noted.

The review tool provides patients a means to identify where their concerns may have emerged along the diagnostic pathway—symptom accuracy, physical exam relevance and accuracy, follow-up, and care planning.

For example, the study found that care planning was significantly associated with self-identified diagnostic concerns.

“Discordance between care planning expectations and symptoms/diagnosis is important because if there is no shared understanding about diagnosis with patients, care will not be sensitive to patients’ preferences, or patients may be left feeling their diagnostic safety was compromised,” the researchers explained.

“A surveillance strategy using the Safer Dx Patient Instrument is sensitive to patients’ experiences by helping uncover negative experiences or patient-perceived care breakdowns that are rarely documented in the medical record and otherwise invisible to the health system because many patients are hesitant to speak up,” they continued.

The study also found that lack of trust in the provider and bad feelings about a visit were associated with self-identified diagnostic concerns.

“Patients and their families experiences of misdiagnosis are associated with reduced trust in their current clinicians,” the researchers wrote. “Interpersonal trust has long been considered an essential aspect of the patient-physician relationship, and increased trust is associated with better patient outcomes.”

Patient concerns about elements of the diagnostic process, like whether notes reflected what they described accurately, were less strongly associated with perceived diagnostic accuracy than trust in the provider.

The study authors suggested that a shared-decision making model adapted for the diagnostic process may facilitate trust.

Provider transparency could further reinforce trust, they said.

“Clinicians could encourage their patients to review their visit notes online and ensure the visit note documentation is comprehensive and accurate and includes relevant discussion around patient values/goals for care,” they said.

“We recommend future research seek to determine predictors of trust in one’s provider since trust appears pivotal for patient perceptions of diagnostic accuracy in our study,” the authors wrote.