Electronic Health Record Use Issues and Diagnostic Error: A Scoping Review and Framework

Ram A. Dixit, Christian L. Boxley, Sunil Samuel, Vishnu Mohan, Raj M. Ratwani, Jeffrey A. Gold

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Background Diagnostic errors are a major source of patient harm, most of which are caused by cognitive errors and biases. Despite research showing the relationship between software systems and cognitive processes, the impact of the electronic health record (EHR) on diagnostic error remains unknown. Methods We conducted a scoping review of the scientific literature to (1) survey the association between aspects of the EHR and diagnostic error, and (2) through a human-systems integration lens, identify the types of EHR issues and their impact on the stages of the diagnostic process. Results We analyzed 11 research articles for the relationship between EHR use and diagnostic error. These articles highlight specific technical, usability, and workflow issues with the EHR that pose risks for diagnostic error at every stage of the diagnostic process. Discussion Although technical problems such as EHR interoperability and data integrity pose critical issues for the diagnostic process, usability and workflow issues such as poor display design, and inability to track test results also hamper clinicians' ability to track, process, and act in the diagnostic process. Current research methods have limited coverage over clinical settings, are not standardized, and rarely include measures of patient harm. Conclusions The available evidence shows that EHRs pose risks for diagnostic error throughout the diagnostic process, with most issues involving their incompatibility with providers' cognitive processing. A structured and systematic model of collecting and reporting on these errors is needed to understand how the EHR shapes the diagnostic process and improve diagnostic accuracy.

Original languageEnglish (US)
Pages (from-to)E25-E30
JournalJournal of patient safety
Issue number1
StatePublished - Jan 1 2023


  • diagnostic error
  • electronic health records
  • human-systems integration
  • information processing
  • patient safety

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health


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