Measuring diagnostic performance is essential to identifying opportunities for improvement. In this study, researchers developed and evaluated two electronic clinical quality measures (eCQMs) to assess the quality of colorectal and lung cancer diagnosis. Each measure used data from the electronic health record (EHR) to identify abnormal test results, evidence of appropriate follow-up, and exclusions that signified unnecessary follow-up. The authors describe the measure testing results and outline the challenges in working with unstructured EHR data.

Medical scribes are increasingly being utilized to reduce the time burden on clinicians for electronic health record (EHR) documentation. In this secondary analysis, researchers identified three themes for safe use of medical scribes: communication aspects, teamwork efforts, and provider characteristics.

… process improvement and support for healthcare workers. … Sittig DF, Lakhani P, Singh H. Applying requisite imagination to safeguard electronic …

Electronic health records (EHRs) serve an important role in clinical communication improvement while harboring threats to safety if not implemented and used correctly. This commentary discusses elements of a guidance package to enhance EHR safety through a 5-step assessment process.

… ensure the viability of the process to improve safety. … Sittig DF, Singh H. Policies to promote shared responsibility for safer …

Based on the Safer Dx and SPADE frameworks, researchers applied a symptom-disease pair-based electronic trigger (e-trigger) to identify patients hospitalized for stroke who had been previously discharged from the emergency department with a diagnosis of headache or dizziness in the preceding 30 days. Analyses show that the e-trigger identified missed diagnoses of stroke with a modest positive predictive value.

… care quality and research. … Morris AH, Stagg B, Lanspa M, et al. Enabling a learning healthcare system with …

Accurate and timely feedback about patient outcomes can inform and improve future clinical decision-making; however, many barriers exist that prevent effective feedback. This article suggests a sociotechnical approach using information technology (IT) to provide clinician feedback. Feedback sent using the electronic health record can be provided asynchronously, by any member of the care team, and in a structured format to ensure relevance and usefulness.

Clinical decision support (CDS) systems are intended to support diagnosis and therapeutic processes of care. This position paper defines adaptive CDS as “systems that can learn and change performance over time, incorporate new clinical evidence, data types, data sources, and methods for interpreting data.” Recommendations for the effective management and monitoring of adaptive CDS are outlined.

Quality measurement is increasingly being incorporated into policies outlining healthcare provider reimbursement. This study compared quality measure calculations between an individual electronic health record (EHR) source and the same EHR source combined with health information exchange (HIE) data. The results show that adding HIE data changed 15% of quality measure calculations. The authors suggest that incorporating HIE data into reimbursement programs could promote more accurate and representative quality measurement.

… have on documentation efficiency, quality, and safety. … Ash JS, Corby S, Mohan V, et al. Safe use of the EHR by medical scribes: a …

… of responsibility . … Rogith D, Satterly T, Singh H, et al. Application of human factors methods to understand … Inform. 2020;11(5):692-698. Epub 2020/10/22. doi: 10.1055/s-0040-1716537 …

… permanent/sustainable methods to prevent harm. … Singh H, Sittig DF, Gandhi TK. BMJ Qual Saf. 2021;30(2):141-145. …

Using root cause analysis data submitted to the Veterans Affairs (VA) National Center for Patient Safety from 2013 to 2018, this study analyzed health information technology (HIT)-related outpatient diagnostic delays to identify common safety concerns. The study identified five high-risk areas for diagnostic delays involving HIT: managing electronic health record inbox notifications and communications, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results.

… reporting guidelines, but complement their use. … Singh H, Sittig DF. A sociotechnical framework for safety-related …

… decision support. … Wright A; McEvoy DS; Aaron S; McCoy AB; Amato MG; Kim H; Ai A; Cimino JJ; Desai BR; El-Kareh R; Galanter W; … Radecki RP; Samal L; Schreiber R; Shelov E; Sirajuddin AM; Sittig DF. …

This direct observation and interview study examined safety activities associated with electronic health records. The study team identified decision making, organizational learning, and frontline user engagement (including clinical decision support and training) as the three critical areas for safe use of electronic health records.

Health information technology (IT) implementation is a complex endeavor that requires a sociotechnical orientation to succeed. This article outlines nine key challenges to safety that must be addressed across the three stages of health IT: design and development; implementation and use; and monitoring, evaluation, and optimization.

… associated with diagnostic error. … Murphy DR, Meyer AN, Sittig DF, Meeks DW, Thomas EJ, Singh H. Application of electronic trigger tools to identify …

Although the implementation of health information technology has improved safety, it has also been associated with unintended consequences that can contribute to patient harm. The SAFER Guides were developed to ensure safe implementation of electronic health records across health care systems. However, the extent to which these best practices have been adopted remains unknown. Researchers examined the degree to which 8 organizations adhered to the 140 SAFER recommendations and found that the majority of best practices were not implemented. Across the 8 sites, 25 of the 140 recommendations were fully implemented. A past PSNet perspective discussed the safety of electronic health records.