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Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework
Ram A Dixit, Christian L Boxley, Sunil Samuel1
1Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, Oregon.
Journal of Patient Safety
|December 20, 2022
Summary
Electronic health records (EHRs) contribute to diagnostic errors due to cognitive processing issues. Addressing EHR usability and workflow problems is crucial for improving diagnostic accuracy and patient safety.
Area of Science:
- Medical Informatics
- Human-Computer Interaction
- Patient Safety
Background:
- Diagnostic errors are a significant cause of patient harm, often stemming from cognitive biases.
- The influence of electronic health records (EHRs) on diagnostic error remains largely unexplored despite known links between software and cognition.
Purpose of the Study:
- To review the scientific literature on the association between EHR aspects and diagnostic error.
- To identify EHR-related issues and their impact on the diagnostic process using a human-systems integration framework.
Main Methods:
- A scoping review of 11 research articles was performed.
- Analysis focused on the relationship between EHR use and diagnostic error, examining technical, usability, and workflow factors.
Main Results:
- EHR technical issues (interoperability, data integrity) and usability/workflow problems (design, result tracking) risk diagnostic errors at all stages.
- These issues impede clinicians' ability to process information and act within the diagnostic pathway.
Conclusions:
- EHRs introduce risks for diagnostic error, primarily due to cognitive processing incompatibilities.
- A systematic approach to reporting EHR-related diagnostic errors is needed to enhance diagnostic accuracy.
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