Analysis of Patient Safety Event Report to Understand the Contribution of Health IT to Diagnostic Error

Abstract

Background: Diagnostic errors are one of the most common and costly medical errors. Most diagnostic errors are due to provider cognitive processes and biases. With the widespread adoption of electronic health records (EHRs), and other health information technology (health IT), EHRs are now the central repository for clinical information and its design and use affect the diagnostic process and diagnostic errors. The goal of this study was to analyze patient safety event reports to determine health IT contributions to diagnostic errors. Understanding how the health IT contributes to diagnostic error will help direct improvement efforts.

Methods: From a data set consisting of 1,110,029 reports entered between 2015 and 2021, from 195 unique health care organizations across the United States, 2618 likely diagnostic error reports were retrieved. A sample of these reports were reviewed and those that were diagnostic related were coded by subject matter experts for whether the diagnostic error was preventable, the stage of the diagnostic process in which the error occurred, the type of error, how much health IT contributed to the error, what health IT system was responsible for the error, whether health IT was directly or indirectly responsible for the error, the type of health IT issue, whether copy and paste was mentioned and contributed to the error, whether the health IT contribution was preventable, the outcome of the error, and the severity of the error.

Results: There were 2618 reports with a general event type category that suggested a diagnostic error. Of these, 119 reports explicitly mentioned health IT and were found to have strong or moderate evidence of health IT contributing to the error. From the remaining 2499 reports, 250 were randomly sampled and 93 (37.2% of 250) had strong or moderate evidence of a health IT contribution. Further analysis of these 212 reports showed EHRs were the most commonly described type of health IT associated with diagnostic errors (58.5%) and most diagnostic errors occurred in the test phase of the diagnostic process (74.5%). Most reports that had health IT as a contributor to the diagnostic error were associated with patient harm (74.5%). There was a trend towards a higher degree of harm when the errors were health IT-related compared with when there was little evidence of health IT contribution.

Conclusions: Health IT, and specifically the EHR, is a contributor to diagnostic errors. To address these issues, improved reporting taxonomies and improvements in health IT system design are needed.

Keywords: diagnostic error; electronic health records; patient safety event reports.