Is Misdiagnosis Inevitable?

Leigh Page

Disclosures

March 28, 2016

In This Article

Using EHRs to Reduce Errors

EHRs have been touted as a key tool to help physicians reduce diagnostic errors. They can provide prompts, collate information from far-flung sources and display it in easily comprehensible graphics, and follow changes in the patient's condition. "When all the records are in the system, you can digitally follow patients' progress and see whether the diagnosis was correct," Dr Wachter says.

However, most of these capabilities are not yet part of basic EHR packages. Users have had to create helpful programs on their own. For example, Dr Dhaliwal has created a "do-it-yourself" program to review patient records and track his own diagnostic decision-making. He says this has become a central feature in his own efforts to improve his cognitive processes.

At Maine Medical Center, Dr Trowbridge says the EHR used by hospitalists displays admission and discharge summaries side by side to instantly show whether their initial diagnosis matches the discharge diagnosis.

Dr Wachter thinks that someday, EHRs may have prompts that question the physician's diagnosis. "If someone comes up with a different diagnosis than what the computer suggests, you might look into the case," he says.

This would involve packing EHRs with clinical decision support (CDS) software, which is already being used as stand-alone systems. CDS systems, such as DXplain and Isabel, download the latest clinical findings and use reasoning processes to provide physicians with a hierarchical list of possible diagnoses.

However, CDS systems have been "tremendously underutilized," Dr Graber says. "Physicians think they're labor-intensive and won't help much, but in fact, they take just a few seconds to use, and clinicians who regularly use them really like them." In a 2015 report,[19] for example, Isabel provided the right diagnosis for a child with a high fever. Emergency physicians had struggled for 2 days to come up with a diagnosis, and the CDS provided it in just seconds.

Conclusion

The movement to reduce misdiagnoses is gathering momentum, but it's still not clear yet how successful it can be. Few healthcare organizations are addressing the problem, and many physicians are still skeptical that diagnostic errors can be identified and averted. In addition, payment systems have to be changed to allow physicians to spend more time on diagnoses.

These changes will be challenging but will be worth the effort, Dr Wachter thinks. "Diagnosis represents a big hole in quality measurement," he says. "Patients need a way to evaluate doctors' diagnostic skills."

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