Pediatricians say EHRs could help prevent errors

By Johnathan Warner
10:58 AM

Electronic health records could help prevent pediatric misdiagnosis, according to a recent survey of 750 pediatricians across the country.

“They felt that EMR and IT could help in decreasing diagnostic errors in pediatrics,” said Geeta Singhal, MD, one of the authors of “Errors of Diagnosis in Pediatric Practice: A Multisite Survey,” conducted by the American Academy of Pediatrics.

“One of the benefits to electronic health records is the ability to quickly look through information that could be scattered or missing in paper- based records,” said Mark Del Beccario, MD, the pediatrician in chief and chief medical information officer at Seattle Children’s Hospital.

The most common errors pediatricians make are related to medications, Del Beccario said, “one of the most studied parts of electronic health records benefits and cited by the Institute of Medicine and Leapfrog as a major initiative to improve care and safety.”

EHRs can “improve communication of information such as referrals and test results, improve coordination between different systems of care, provide clinical decision support such as alerts and reminders for key diagnostic steps, provide information at the point of care, and allow the information to be displayed in a visual format accessible to medical personnel,” said Singh Hardeep, MD, one of the report’s authors.

However, EHRs are but one facet of a potential solution to a problem that can have multiple causes, Hardeep said.
 “It's an issue of multifactoral origin that’s going to see solutions that are manyfold,” said Singhal. “It won't be that IT’s the one bullet to take care of it.”
A barrier in preventing diagnostic errors using EHRs and other IT has been the low rate of adoption and use of the technology.

Daniel R. Neuspiel, MD, director of ambulatory pediatrics at Levine Children’s Hospital, said the primary obstacles to adopting EHRs are “mainly inertia, fear of loss of control by physicians and general resistance to change.”

Meanwhile the work toward greater patient safety goes on. 
“We will continue to conduct high quality research into potential solutions and use that to implement improvement strategies into clinical practice,” said Hardeep.

Neuspiel said Levine Children’s Hospital has “implemented checklists for nurses in our practice, which include standardization of screening tests so that some important diagnoses are not missed.”
One other way to reduce the chance of misdiagnosis is enhancing communication between doctor and the patient or the parents through e-mail.

“E-mail is an additional tool that helps in communication but does not replace face-to-face care,” said Del Beccario. “It works best when information is needed for clarification or follow-up, and when the information is not time sensitive. It does have its place, however, and like any other tool has been a helpful way to communicate.”

Despite the knowledge that EHRs and other forms of IT can help prevent misdiagnosis in pediatrics and other fields of medicine, the study of misdiagnosis is, as Singhal put it, “very new and very understudied, and in pediatrics, this is the first study that we know of that’s been done that even looks at pediatrics, so there are a lot more questions than answers.”

“This issue is not restricted to a single system, single specialty or private or public institutions,” Hardeep said. “It is an issue that is seen across all systems and providers and is of international significance.”

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