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Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

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2194-802X
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Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process

Martha Quinn / Jane Forman / Molly Harrod / Suzanne Winter / Karen E. Fowler / Sarah L. Krein
  • Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
  • Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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/ Ashwin Gupta
  • Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
  • Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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/ Sanjay Saint
  • Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
  • Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
  • Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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/ Hardeep Singh
  • Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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/ Vineet Chopra
  • Corresponding author
  • Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
  • Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Published Online: 2018-11-29 | DOI: https://doi.org/10.1515/dx-2018-0036

Abstract

Background

Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication.

Methods

We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis. To validate findings, interviews and focus groups were conducted with physicians. Field notes and interview/focus group transcripts were reviewed and themes identified using content analysis.

Results

Existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making. Further, the EHR created data overload and data fragmentation, making integration for diagnosis difficult. To improve diagnosis, physicians recommended replacing pagers with two-way communication devices, restructuring the EHR to facilitate access to key information and improving training on EHR systems.

Conclusions

As advances in health information technology evolve, challenges in the way clinicians share information during the diagnostic process will rise. To improve diagnosis, changes to both the technology and the way in which we use it may be necessary.

Keywords: challenges and opportunities; clinician communication; diagnostic error; diagnostic process; electronic health records; health data sharing; medical diagnosis

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About the article

Corresponding author: Vineet Chopra, MD, MSc, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; and Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109, USA

aMartha Quinn and Jane Forman contributed equally to the development of this paper.


Received: 2018-06-26

Accepted: 2018-10-19

Published Online: 2018-11-29


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: This project was supported by grant number P30HS024385 from the Agency for Healthcare Research and Quality (funder id: 10.13039/100000133). The funding source played no role in study design, data acquisition, analysis or decision to report these data. Dr. Chopra is supported by funding from the Agency of Healthcare Research and Quality (1-K08-HS022835-01 and 1 R18 HS025891-01). Dr. Krein is supported by a VA Health Services Research and Development Research Career Scientist Award (RCS 11-222). Dr. Singh is partially supported by Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the Department of Veterans Affairs.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Diagnosis, 20180036, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0036.

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