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    How EHRs Can Help Overcome Missed Diagnoses


    Missed or delayed diagnoses—diagnostic errors—at healthcare organizations are common and they can have serious consequences. But using structured technology tools can help avoid them.

    That’s according to patient care improvement research organization, ECRI Institute, which names diagnostic errors the number one concern on its 2018 Top 10 Patient Safety Concerns for Healthcare Organizations.

    “Aside from the fact that diagnostic errors can result in significant harm to patients, for the healthcare executive there is concern about the quality of care they deliver, the possible damage to their reputation, and the financial liability on their organizations,” says Gail M. Horvath, MSN, RN, CNOR, CRCST, patient safety analyst/consultant III, ECRI Institute. 

    Various studies point to alarming rates of diagnostic errors. Here are just a few:

    • According to the Academies of Medicine, diagnostic errors occur in one out of 10 diagnoses made and account for 40,000 to 80,000 U.S. deaths annually.
    • A large observational study, published in the BMJ, found that diagnostic errors affect at least one in 20 U.S. adults with approximately 50% resulting in harm.
    • According to the Harvard Medical Practice Study, diagnostic error accounted for 17% of preventable errors in hospitalized patients.

    A Johns Hopkins study that reviewed 25 years of U.S. malpractice claim payouts between 1986 and 2010, found that diagnostic errors accounted for the largest fraction of the claims, resulted in the most severe patient harm, and resulted in the highest total of payouts that totaled $38.8 billion.

    Technology tools


    EHRs can help avoid missed diagnoses through use of clinical decision support tools, according to Horvath. “Diagnostic algorithms can be used to rule out alternative diagnosis and be an aide to pointing the clinician in the right direction,” she says.

    Organizations can also leverage their EHRs to improve patient engagement and communication, therefore also reducing the likelihood of a missed diagnoses.

    For example, healthcare organizations can develop and implement processes within the EHR to ensure effective and timely communication between diagnostic testing healthcare professionals and treating healthcare professionals through alerts and reminders. EHRs can also require documentation of communication of results to patients, which helps ensure patients not only receive results but have the opportunity to engage with providers regarding them, according to Horvath.

    “This is particularly salient when the patient has left the hospital before results are known,” she says.

    In the era of patient- and family-centered care, the patient and family should be equal partners in the healthcare team, according to Horvath.

    “Patients and families should be encouraged to access patient portals to see lab results and other testing information and follow up with their physician—especially of the practice had not contacted patients with their results,” she says. “Also, it is essential for healthcare providers to assess the health literacy of their patients when reporting results to them so that they understand what is being reported and what recommendations are for follow up and/or treatment.”

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