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J Pathol Inform. 2018 Apr 2;9:8. doi: 10.4103/jpi.jpi_70_17. eCollection 2018.

Challenges in Communication from Referring Clinicians to Pathologists in the Electronic Health Record Era.

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Department of Pathology, Yale School of Medicine, New Haven, CT, United States of America.
Department of Pathology, University of California San Diego, CA, United States of America.
Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, CT, United States of America.
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and the Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.


We report on the role played by electronic health record inbox messages (EHRmsg) in a safety event involving pathology. Evolving socio-cultural norms led to the coopting of EHRmsg for alternate use and oversight of a clinician to pathologist request. We retrospectively examined EHR inbox messages to pathologists over a 3 month block. 36 messages from 22 pathologists were assessed. 26 pertained to patient care including requests for report corrections and additional testing. 88% of requests had gone unaddressed. Clinicians assumed that pathologists used EHRmsg as clinical care team members, however, pathologists rarely did. Communication gaps exist between primary clinicians and pathologists in the EHR era and they have potential to result in patient harm. Different sociocultural norms and practice patterns between specialties underlie some of the breakdowns. Health information technology implementation needs to proactively look for new sociotechnical failure modes to avoid patient harm from communication lapses.


Communication; electronic health record; pathology

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