Patients report symptoms, but they are hard to find in the EHR

Andis Robeznieks , Senior News Writer

Physicians and health informatics experts met in Washington last month to find ways to turn medical data into clinically relevant, actionable information that can be used to develop quicker and more accurate diagnoses and save lives.

The objective of the physician experts convened by the AMA and the members of the National Quality Forum, an organization that develops consensus on quality measures, is to define terms and identify data characteristics regarding patient symptoms that can be better used and more easily shared.

Advancing public health

AMA membership offers unique access to savings and resources tailored to enrich the personal and professional lives of physicians, residents and medical students.

Limited-time half-price dues when you join!

Despite being critical to the diagnostic process, symptom data is not consistently recorded or defined in EHR systems, which impedes physicians’ access to information they need to provide accurate, timely diagnoses.

The AMA-National Quality Forum collaboration will help EHR vendors make critical information available for clinical decision support. Because of a lack of interoperability and other challenges, physicians still struggle to convert the massive amount of medical data in the EHR into clinically relevant, useful knowledge.

This is particularly true with symptom data. Because EHRs lack structured fields for symptom data, they are often not recorded in a consistent or shareable manner.

Supplying symptom data in this fashion is an important step toward preventing diagnostic errors.

"Consistent symptom data standards would provide an important data point for physicians," said AMA President Jesse M. Ehrenfeld, MD, MPH. “We see this as actionable information that will strengthen the diagnostic process and look forward to participating and seeing the results.”

The AMA-National Quality Forum collaboration represents a welcome change in health IT, as physician input has not always been sought in the development of digital health tools and data standards, leading to frustration and adding to burnout among doctors. This new collaboration—funded by the Gordon and Betty Moore Foundation—is intended to give physicians early input into the design of new standards that will be useful in real-world situations.

By optimizing the collection, use and sharing of standardized symptom data by front-line physicians, the accuracy, timeliness and quality of diagnoses should be enhanced.

“Patients place a great deal of trust in doctors, nurses and other health care professionals, who rely on the information patients provide about their conditions, health history and symptoms,” said Elizabeth Drye, MD, the National Quality Forum’s chief scientific officer. “For patient safety and to improve the care experience, it is vitally important to develop consensus on symptom data standards with input from clinicians who rely on these data to improve diagnosis and care.”

The key terms and data characteristics identified by participating physicians will be put through the Health Level Seven (HL7) international standards-setting consensus process to further enhance health systems’ ability to communicate and share data.

The first meeting, held May 14, was devoted to the symptom of dizziness as an early presentation of stroke. While physicians may first specifically seek to rule out stroke while examining a patient experiencing dizziness, that symptom is found in so many other conditions that it is challenging to make a timely diagnosis.

A 2015 report from the Institute of Medicine, now the National Academy of Medicine,  notes that “the percent of patients presenting to the emergency department with dizziness who underwent computed tomography scans rose from 9% in 1995 to 40% in 2013, although there has been no increase in diagnoses of stroke or other neurologic diseases.”

“Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions,” that report says. “Improving the diagnostic process is not only possible, but also represents a moral, professional and public health imperative.”