Framework aims to employ e-triggers to improve diagnostic safety
- Use of electronic triggers to identify diagnostic errors or possible adverse events could improve patient safety both in real time and retrospectively by helping to guide diagnostic improvements, an article in BMJ Quality and Safety suggests.
- The authors — from Michael E DeBakey Veterans Affairs Medical Center and University of Texas-Memorial Hermann Center for Healthcare Quality and Safety — offer a framework for health systems in developing and deploying e-trigger tools to detect and measure diagnostic errors using EHR data.
- Such tools would not only detect potential diagnostic events and monitor error rates but also help to identify patients at greater risk of future adverse events, the authors say.
Challenges to quality diagnosis range from inadequate communication during patient transfers to lack of performance measures to guide improvements and limited tools to help doctors evaluate symptoms and test results.
EHRs hold great potential for improving patient safety, but only if they are designed and programed properly to do so. E-trigger tools are the next step for vendors to help providers use data to detect diagnostic errors and trends and identify targets for enhancing patient safety.
The proposed framework walks providers through the process of identifying and prioritizing which diagnostic errors to focus on, defining criteria to detect errors, determining potential data sources, building an e-trigger algorithm and testing, assessing and refining the tools' performance.
The process can work, but only if health systems invest in clinical informatics and health IT and safety personnel, the authors noted.
"Use of e-triggers as diagnostic safety indicators is promising for identifying historic trends, generating feedback and learning, facilitating understanding of underlying contributory processes and informing improvement strategies," they write. "Additionally, certain e-triggers can help health systems intervene to prevent patient harm if applied prospectively."
They call for future research in natural language processing and machine learning to increase the effectiveness of e-triggers.
The proposed framework comes as providers are stepping up efforts to reduce incorrect or delayed diagnoses, which account for up to 80,000 deaths annually in U.S. hospitals. Last month, more than 40 healthcare organizations and patient advocacy groups banded together to increase diagnostic accuracy by engaging stakeholders to take practical steps like improving how doctors communicate test results. Among the coalition's members are Geisinger, Intermountain Healthcare and MedStar Health.
The issue also has support in Congress. The fiscal year 2018 Omnibus Appropriations Act instructed the Agency for Healthcare Research and Quality to create a cross-agency working group to study the problem and develop a plan to fuel more research on ways of improving diagnoses. The measure also advocates public-private partnerships and centers of excellence to support that goal.