Symptom Tracking in Primary Care: Designing and Testing an EHR–Embedded Safety-Net System

IF 3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2026-10-01 Epub Date: 2026-06-02 DOI:10.1016/j.jcjq.2026.05.012

Talya Salant MD, PhD (is Director of Community Health Research, Bowdoin Street Health Center, Dorchester, Massachusetts, and Instructor of Medicine, Beth Israel Deaconess Medical Center, Boston.), James Benneyan PhD (is Professor, and Executive Director, Healthcare Systems Engineering Institute, Northeastern University.), Anthony Zhong (is MD and MPH Candidate, and Research Affiliate, Harvard Medical School.), Jasper Su (is MS Candidate, and Research Coordinator, Healthcare Systems Engineering Institute, Northeastern University.), Molly Hodsden (formerly Research Assistant, Healthcare Systems Engineering Institute, Northeastern University, is Continuous Improvement Engineer, Flexible OR Solutions, Boston.), Seth J. Berkowitz MD (is Interventional Radiologist, and Medical Director of Radiology Informatics, Beth Israel Deaconess Medical Center.), Russell Phillips MD (is Senior Advisor on Innovation in Primary Care, Division of General Medicine, Beth Israel Deaconess Medical Center, and Professor of Medicine, Harvard Medical School.), Gordon D. Schiff MD (is Professor, and Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston. Please address correspondence to Talya Salant)

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Berkowitz MD (is Interventional Radiologist, and Medical Director of Radiology Informatics, Beth Israel Deaconess Medical Center.), Russell Phillips MD (is Senior Advisor on Innovation in Primary Care, Division of General Medicine, Beth Israel Deaconess Medical Center, and Professor of Medicine, Harvard Medical School.), Gordon D. Schiff MD (is Professor, and Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston. Please address correspondence to Talya Salant)","doi":"10.1016/j.jcjq.2026.05.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Systematic tracking of worrisome symptoms in primary care is an important but underdeveloped safety-net approach for preventing missed or delayed serious diagnoses. A reliable symptom tracking system monitors symptoms (for example, abdominal pain, weight loss) to ensure that they either resolve or appropriate action is taken. 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引用次数: 0

Abstract

Background

Systematic tracking of worrisome symptoms in primary care is an important but underdeveloped safety-net approach for preventing missed or delayed serious diagnoses. A reliable symptom tracking system monitors symptoms (for example, abdominal pain, weight loss) to ensure that they either resolve or appropriate action is taken. Limited examples of reliable symptom tracking systems exist in primary care. The authors aimed to design and test a novel electronic health record (EHR)–embedded symptom tracking system to improve follow-up on worrisome symptoms in a Boston-based primary care community clinic.

Methods

Baseline worrisome symptom follow-up rates were determined using historical chart review, measuring whether symptom follow-up was documented and the time to symptom reassessment. A team of systems engineers and primary care clinicians designed and tested iterative prototypes of a worrisome symptom tracking system, resulting in an EHR–embedded tool where symptom tracking orders could be placed and systematically tracked. Measures of success included improved completion rates and timeliness of symptom follow-up using the system compared to historical follow-up rates.

Results

The symptom tracking system was feasible and effective in improving symptom follow-up rates (84.8% vs. 60.5%, p = 0.004) and mean timeliness (20 vs. 101.6 days, p = 0.002) of symptom follow-up compared to historical data.

Conclusion

A pilot symptom tracking system was feasible, accepted by busy primary care clinicians, and resulted in improved reliability and timeliness of symptom follow-up. Broader implementation and evaluation of EHR–embedded symptom tracking systems will require redesigned clinical workflows to optimize the efficiency and sustainability of such systems as a routine component of primary care.

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初级保健的症状追踪：设计和测试ehr嵌入式安全网系统。

背景：在初级保健系统跟踪令人担忧的症状是一个重要的，但不发达的安全网方法，以防止遗漏或延迟严重诊断。一个可靠的症状跟踪系统监测症状（例如，腹痛、体重减轻），以确保它们得到解决或采取适当的行动。在初级保健中存在的可靠症状跟踪系统的例子有限。作者旨在设计和测试一种新型的电子健康记录（EHR）嵌入式症状跟踪系统，以改善波士顿初级保健社区诊所对令人担忧的症状的随访。方法：采用回顾病史的方法确定基线担忧症状随访率，测量是否有症状随访记录和重新评估症状的时间。一个由系统工程师和初级保健临床医生组成的团队设计并测试了令人担忧的症状跟踪系统的迭代原型，从而产生了一个嵌入电子病历的工具，可以在其中放置症状跟踪订单并进行系统跟踪。成功的衡量标准包括与历史随访率相比，使用该系统改善的完成率和症状随访的及时性。结果：与历史资料相比，症状追踪系统在提高症状随访率（84.8% vs. 60.5%, p = 0.004）和平均时效性（20 vs. 101.6天，p = 0.002）方面是可行有效的。结论：试点症状跟踪系统是可行的，被忙碌的初级保健临床医生接受，提高了症状随访的可靠性和及时性。更广泛地实施和评估嵌入ehr的症状跟踪系统将需要重新设计临床工作流程，以优化此类系统作为初级保健常规组成部分的效率和可持续性。

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