Language
English
Publication Date
8-1-2025
Journal
Journal of Telemedicine and Telecare
DOI
10.1177/1357633X241236570
PMID
38557263
Abstract
Introduction
The COVID-19 pandemic advanced the use of telehealth-facilitated care. However, little is known about how to measure safety of clinical diagnosis made through telehealth-facilitated primary care.Methods
We used the seven-step Safer Dx Trigger Tool framework to develop an electronic trigger (e-trigger) tool to identify potential missed opportunities for more timely diagnosis during primary care telehealth visits at a large Department of Veterans Affairs facility. We then applied the e-trigger algorithm to electronic health record data related to primary care visits during a 1-year period (1 April 2020–31 March 2021). The algorithm identified patients with unexpected visits within 10 days of an index telemedicine visit and classified such records as e-trigger positive. We then validated the e-trigger's ability to detect missed opportunities in diagnosis using chart reviews based on a structured data collection instrument (the Revised Safer Dx instrument).Results
We identified 128,761 telehealth visits (32,459 unique patients), of which 434 visits led to subsequent unplanned emergency department (ED), hospital, or primary care visits within 10 days of the index visit. Of these, 116 were excluded for clinical reasons (trauma, injury, or childbirth), leaving 318 visits (240 unique patients) needing further evaluation. From these, 100 records were randomly selected for review, of which four were falsely flagged due to invalid data (visits by non-providers or those incorrectly flagged as completed telehealth visits). Eleven patients had a missed opportunity in diagnosis, yielding a positive predictive value of 11%.Discussion
Electronic triggers that identify missed opportunities for additional evaluation could help advance the understanding of safety of clinical diagnosis made in telehealth-enabled care. Better measurement can help determine which patients can safely be cared for via telemedicine versus traditional in-person visits.Keywords
Humans, Telemedicine, COVID-19, Primary Health Care, Diagnostic Errors, Female, Male, Electronic Health Records, Middle Aged, Algorithms, Aged, United States, SARS-CoV-2, Adult
Published Open-Access
yes
Recommended Citation
Murphy, Daniel R; Kadiyala, Himabindu; Wei, Li; et al., "An Electronic Trigger To Detect Telemedicine-Related Diagnostic Errors" (2025). Faculty and Staff Publications. 4482.
https://digitalcommons.library.tmc.edu/baylor_docs/4482