Reducing diagnostic errors through effective communication: harnessing the power of information technology

Abstract

Diagnostic errors are poorly understood despite being a frequent cause of medical errors. Recent efforts have aimed to advance the "basic science" of diagnostic error prevention by tracing errors to their most basic origins. Although a refined theory of diagnostic error prevention will take years to formulate, we focus on communication breakdown, a major contributor to diagnostic errors and an increasingly recognized preventable factor in medical mishaps. We describe a comprehensive framework that integrates the potential sources of communication breakdowns within the diagnostic process and identifies vulnerable steps in the diagnostic process where various types of communication breakdowns can precipitate error. We then discuss potential information technology-based interventions that may have efficacy in preventing one or more forms of these breakdowns. These possible intervention strategies include using new technologies to enhance communication between health providers and health systems, improve patient involvement, and facilitate management of information in the medical record.

Fig. 1

A Framework Integrating the Diagnostic Process with Communication Breakdowns. **Message reception can lead directly to data synthesis (and hence action) without message acknowledgement in some cases. Interpersonal communication, Informational communication, Interpersonal communication, Informational communication. a. Collaborative goal-setting using an Information Technology platform (Example 1 from table), b. Use of personal health records (Example 2), c. Using electronic progress notes requiring co-signatures of physician (Example 5), d. Electronic Medical Record generated report transmitted to pager or mobile phone of referring physician (Example 7), e. Use of alerts for abnormal test results (Example 10), f. Electronic Medical Record generated reminders to patient and physician (Example 3), g. Using software to track unacknowledged alerts (Example 12)