Health IT and Diagnostic Safety: Promise and Peril
Meanwhile, physicians and hospitals must do their best with current systems and help improve and create systems for the future. Ongoing evaluation of system performance will always be important. A 2015 study found misleading and unreliable graphical displays of diagnostic laboratory test results (Sittig et al., 2015). The authors measured the accuracy of data displayed in EHR systems from eight leading vendors across 11 criteria (e.g., patient ID is visible, precise data point values are available) and found all to be lacking, some dramatically so (Sittig et al., 2015). Accuracy must not be taken for granted.
Technology as scapegoat
Widespread agreement that current EHRs are imperfect may lead to misunderstandings about the causes of safety problems, including misdiagnosis. The mismanagement of the first patient to be diagnosed with Ebola in the United States provides an example. Thomas Eric Duncan had just arrived from Liberia, where Ebola was endemic, when he went to the emergency department (ED) of a hospital in Dallas in 2014. He presented with fever, nausea, and other symptoms consistent with Ebola and told the triage nurse he had recently been in Africa. The ED physician who evaluated Duncan was not aware of his travel history, which the nurse had recorded in the EHR. The physician diagnosed Duncan with sinusitis and sent him home. Duncan returned to the ED two days later, was admitted, tested for Ebola, diagnosed, and died from the disease 10 days after admission. The hospital originally blamed the misdiagnosis on the EHR, claiming it had failed to deliver the information about Duncan’s travels to the physician—but later admitted that was not true (Cortese, Abbo, Chassin, Lyon, & Riley, 2015).
Experts who have studied the failures in Duncan’s care found that overreliance on the EHR and lack of interprofessional teamwork contributed to the missed diagnosis (Cortese et al., 2015; Upadhyay, Sittig, & Singh, 2014). Upadhyay et al. (2014) admit, “physicians tend to ignore nursing notes, whether on paper or in the EHR” (p. 285). Inferior design or implementation cannot always be blamed for failures. Indeed, poorly designed systems can easily become scapegoats and obscure the true cause of adverse events.
Health IT systems, including EHRs, can be used effectively to improve diagnosis, but must be designed, implemented, and evaluated with care. Overly optimistic beliefs about the ability of health information technology to fix safety problems or even to be accurate, as well as blanket assumptions that EHRs are always to blame, are counterproductive.
Susan Carr is editor of Patient Safety & Quality Healthcare.
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