Computable phenotype for diagnostic error: developing the data schema for application of symptom-disease pair analysis of diagnostic error (SPADE)

Abstract

Objectives: Diagnostic errors are the leading cause of preventable harm in clinical practice. Implementable tools to quantify and target this problem are needed. To address this gap, we aimed to generalize the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) framework by developing its computable phenotype and then demonstrated how that schema could be applied in multiple clinical contexts.

Methods: We created an information model for the SPADE processes, then mapped data fields from electronic health records (EHR) and claims data in use to that model to create the SPADE information model (intention) and the SPADE computable phenotype (extension). Later we validated the computable phenotype and tested it in four case studies in three different health systems to demonstrate its utility.

Results: We mapped and tested the SPADE computable phenotype in three different sites using four different case studies. We showed that data fields to compute an SPADE base measure are fully available in the EHR Data Warehouse for extraction and can operationalize the SPADE framework from provider and/or insurer perspective, and they could be implemented on numerous health systems for future work in monitor misdiagnosis-related harms.

Conclusions: Data for the SPADE base measure is readily available in EHR and administrative claims. The method of data extraction is potentially universally applicable, and the data extracted is conveniently available within a network system. Further study is needed to validate the computable phenotype across different settings with different data infrastructures.

Keywords: diagnostic error; misdiagnosis; symptom-disease pair analysis of diagnostic error (SPADE).

Figure 1.

Idealized causal sequence in the interaction between patient and provider. Patients seek medical attention. The provider takes time, ultimately treating and releasing. Sometime later, the patient returns and provider notes harm that has occurred. The iconography is based on the UML Sequence Diagram standard. [ OMG^® Unified Modeling Language^® (OMG UML^®) Version 2.5.1: Object Modeling Group;2017. <https://www.omg.org/spec/UML/2.5.1/PDF>, Jan 28, 2024]

Figure 2:

SPADE Information Model Diagram. Schema database managers and programmers can use this diagram as a basis for implementing SPADE locally. The Classes represent the core meaning of tables in the local database: Patient, Provider, Step, Assessment, and Clinical Finding, although in a particular database, the tables used may have different names. The information listed in the top half of each box represents the meaning of the fields in those tables. The braces ({}) indicate permitted values, either as defined by this diagram (e.g., “missedOpportunity”) or by an external vocabulary (e.g., ICD10). The Actions in the bottom half denote what members of the Class can do. So, a Patient may Seek Medical Attention. The arrows (→) show that the information in one member of a Class can refer to members of other Classes. Thus, a member of the Class Assessment has an information element, Based On Steps, which is a list of references to members of the Class, Step. The iconography is based on the UML Class Diagram standard. [ OMG^® Unified Modeling Language^® (OMG UML^®) Version 2.5.1: Object Modeling Group;2017. <https://www.omg.org/spec/UML/2.5.1/PDF>, Jan 28, 2024]