EHRs and Diagnostic Errors

Currently the majority of physicians who have electronic medical records obtained them and use them largely for reimbursement-related purposes.  They facilitate electronic claims submission and the collection of information and documentation needed to justify reimbursement for certain services and procedures.  Proponents of electronic health records have cited the possibility not just of administrative savings, but of substantial improvements in health care quality from more widespread use, including the ability to better coordinate care.  A New England Journal of Medicine perspective looks at how EHRs might help improve diagnostic accuracy.  (NEJM Perspective)

While there is an awareness of certain categories of medical mistakes, such as medication errors or egregious surgical problems like removing the wrong limb or leaving a sponge or instrument in a patient, the largest single set of errors is wrong or missed diagnoses of patients’ health problems.  Physicians have adopted a variety of methods for making a differential diagnosis, but these may often just be carried in the doctor’s head and in a paper system, it may be hard for the physician to easily assemble and review all the pertinent information about the patient.

EHRs could facilitate this process, but as the author notes, work needs to be done on how most current systems fit into physician workflows and work processes.  To date most physicians who have implemented an EMR have found the process excruciatingly painful and often not worth the time and effort involved.  The authors suggest that good EHRs would help with accurate diagnoses by assisting in gathering all relevant information, allowing for a longitudinal view of the patient and easier identification of trends, provide feedback and prompts to assist the physician in considering possible sources of the patient’s symptoms and offering additional sources of information and even consultations with experts.  This perspective helps advance the understanding of what would make electronic records truly able to easily help physicians with the crucial task of diagnosing a patient’s condition.