ArticleJournal of the American Medical Informatics Association : JAMIA2022
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
Article in Journal of the American Medical Informatics Association : JAMIA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04166240 (Measuring and Improving the Safety of Test Result Follow-Up), which is not on this map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Measuring and Improving the Safety of Test Result Follow-Up
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation.Diagnosis (Berlin, Germany) · 2025Pooled it
- Scoping review of patient and family engagement interventions in diagnosis: a paradox of too much, yet so little.BMJ quality & safety · 2026Article
- Ten years on: how far have we come in patient engagement in diagnosis?Diagnosis (Berlin, Germany) · 2025Review
- Charting Diagnostic Safety: Exploring Patient-Provider Discordance in Medical Record Documentation.Journal of general internal medicine · 2025Article
- Evolving a Healthcare System With a Coordinated Approach for Patient-Reported Measurement of Diagnostic Quality Comment on "Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens".International journal of health policy and management · 2025Article
- Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis.BMJ quality & safety · 2024Article
- Patient-Clinician Diagnostic Concordance upon Hospital Admission.Applied clinical informatics · 2024Article
- Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens.International journal of health policy and management · 2024Article
- Patient Reasoning: Patients' and Care Partners' Perceptions of Diagnostic Accuracy in Emergency Care.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference.Applied clinical informatics · 2023Article
- Article
- Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Centering the patient in informatics applications.Journal of the American Medical Informatics Association : JAMIA · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundThe 21st Century Cures Act mandates patients' access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review.
objectiveTo test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes.
methodsIn a large integrated health system, patients aged 18-85 years actively using the patient portal and seen between October 2019 and February 2020 were invited to respond to an online questionnaire if an EHR algorithm detected any recent unexpected return visit following an initial primary care consultation ("at-risk" visit). We developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to several dimensions of the diagnostic process based on notes review and recall of recent "at-risk" visits. Additional questions assessed patients' trust in their providers and their general feelings about the visit. The primary outcome was a self-reported diagnostic concern. Multivariate logistic regression tested whether the primary outcome was predicted by instrument variables.
resultsOf 293 566 visits, the algorithm identified 1282 eligible patients, of whom 486 responded. After applying exclusion criteria, 418 patients were included in the analysis. Fifty-one patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "the care plan the provider developed for me addressed all my medical concerns" [odds ratio (OR), 2.65; 95% confidence interval [CI], 1.45-4.87) and "I trust the provider that I saw during my visit" (OR, 2.10; 95% CI, 1.19-3.71) and agreed with the statement "I did not have a good feeling about my visit" (OR, 1.48; 95% CI, 1.09-2.01).
conclusionPatients can identify diagnostic concerns based on a proactive online structured evaluation of visit notes. This surveillance strategy could potentially improve transparency in the diagnostic process.
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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.