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An electronic trigger to detect telemedicine-related diagnostic errors.

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Summary

An electronic trigger tool identified potential missed diagnoses in telehealth primary care. The tool showed an 11% positive predictive value for missed diagnostic opportunities, highlighting areas for improved telehealth safety.

Keywords:
Telehealthdiagnostic errorsquality‌safetytelemedicinetriggers

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Area of Science:

  • Health Informatics
  • Patient Safety
  • Primary Care Medicine

Background:

  • The COVID-19 pandemic accelerated telehealth adoption in primary care.
  • Assessing the diagnostic safety of telehealth primary care remains a challenge.

Purpose of the Study:

  • To develop and validate an electronic trigger (e-trigger) tool for identifying potential missed diagnostic opportunities in telehealth primary care.
  • To evaluate the safety of clinical diagnoses made during telehealth visits.

Main Methods:

  • Utilized the Safer Dx Trigger Tool framework to create an e-trigger algorithm.
  • Applied the e-trigger to electronic health record data from 128,761 telehealth visits (April 2020-March 2021).
  • Validated e-trigger positive cases through chart reviews using the Revised Safer Dx instrument.

Main Results:

  • Identified 318 potentially concerning telehealth visits requiring further evaluation.
  • Chart review of 100 randomly selected cases revealed 11 instances of missed diagnostic opportunities.
  • The e-trigger demonstrated an 11% positive predictive value for missed opportunities.

Conclusions:

  • Electronic triggers can aid in evaluating the safety of telehealth-enabled primary care.
  • Improved measurement of diagnostic safety is crucial for determining appropriate use of telemedicine versus in-person visits.