ArticleBMJ quality & safety2012
Electronic health record-based surveillance of diagnostic errors in primary care.
Article in BMJ quality & safety, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
54 citing papers in PubMed.
- Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A Cluster Randomized Controlled Trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2015Trial
- Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors.Diagnostics (Basel, Switzerland) · 2026Review
- Why digital health fails silently: a sociotechnical theory of health information technology-related risk.Frontiers in digital health · 2026Article
- Diagnostic errors in patients admitted directly from new outpatient visits.Diagnosis (Berlin, Germany) · 2025Article
- Epidemiology of diagnostic errors in pediatric emergency departments using electronic triggers.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Implementation of Electronic Triggers to Identify Diagnostic Errors in Emergency Departments.JAMA internal medicine · 2025Article
- Computable phenotype for diagnostic error: developing the data schema for application of symptom-disease pair analysis of diagnostic error (SPADE).Diagnosis (Berlin, Germany) · 2024Article
- Longitudinal Changes in Diagnostic Accuracy of a Differential Diagnosis List Developed by an AI-Based Symptom Checker: Retrospective Observational Study.JMIR formative research · 2024Article
- Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.Journal of hospital medicine · 2023Article
- Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.Diagnosis (Berlin, Germany) · 2023Article
- A taxonomy of early diagnosis research to guide study design and funding prioritisation.British journal of cancer · 2023Review
- Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients.Biomolecules & biomedicine · 2023Observational
- Physicians' Perspectives on a Multi-Dimensional Model for the Roles of Electronic Health Records in Approaching a Proper Differential Diagnosis.Journal of personalized medicine · 2023Article
- A comprehensive framework to estimate the frequency, duration, and risk factors for diagnostic delays using bootstrapping-based simulation methods.BMC medical informatics and decision making · 2023Article
- Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network.BMJ open quality · 2023Article
- Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study.BMJ open · 2023Article
- Use of e-triggers to identify diagnostic errors in the paediatric ED.BMJ quality & safety · 2022Article
- Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History-Taking System With a Differential Diagnosis Generator: Retrospective Observational Study.JMIR medical informatics · 2022Article
- Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.BMJ quality & safety · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundDiagnostic errors in primary care are harmful but difficult to detect. The authors tested an electronic health record (EHR)-based method to detect diagnostic errors in routine primary care practice.
methodsThe authors conducted a retrospective study of primary care visit records 'triggered' through electronic queries for possible evidence of diagnostic errors: Trigger 1: A primary care index visit followed by unplanned hospitalisation within 14 days and Trigger 2: A primary care index visit followed by ≥1 unscheduled visit(s) within 14 days. Control visits met neither criterion. Electronic trigger queries were applied to EHR repositories at two large healthcare systems between 1 October 2006 and 30 September 2007. Blinded physician-reviewers independently determined presence or absence of diagnostic errors in selected triggered and control visits. An error was defined as a missed opportunity to make or pursue the correct diagnosis when adequate data were available at the index visit. Disagreements were resolved by an independent third reviewer.
resultsQueries were applied to 212 165 visits. On record review, the authors found diagnostic errors in 141 of 674 Trigger 1-positive records (positive predictive value (PPV)=20.9%, 95% CI 17.9% to 24.0%) and 36 of 669 Trigger 2-positive records (PPV=5.4%, 95% CI 3.7% to 7.1%). The control PPV of 2.1% (95% CI 0.1% to 3.3%) was significantly lower than that of both triggers (p≤0.002). Inter-reviewer reliability was modest, though higher than in comparable previous studies (к=0.37 (95% CI 0.31 to 0.44)).
conclusionsWhile physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.