October 10, 2017

How Geisinger, BWH, and UPMC plan to curb misdiagnoses

Daily Briefing

Geisinger Medical Center, Brigham and Women's Hospital, and other industry stakeholders are launching new initiatives aimed at curbing the rate of inaccurate or delayed diagnoses—including four innovative endeavors that capitalize on artificial intelligence, EHRs, and networking, Laura Landro writes for the Wall Street Journal.

Why the EHR life cycle is just like raising a child

Background

According to Landro, misdiagnoses are a leading cause of medical malpractice suits in the United States. In fact, according to a 2015 report, the majority of patients will experience at least one diagnostic error in their lifetimes, including some errors that have "devastating consequences." For decades, incorrect or slow diagnoses have been "a blind spot in the delivery of quality care," the report stated.

But this blind spot means "there is a huge opportunity to put knowledge and tools into the hands of clinicians to help them make a better or more timely and accurate diagnosis," Janet Corrigan, the head of the patient care program at the Gordon and Betty Moore Foundation said. Landro spotlights four of the leading initiatives aimed at addressing medical misdiagnoses:  

1. Geisinger's EHR project

To address diagnostic errors, Geisinger Medical Center is implementing the Safer Dx Learning Lab, the first computerized program that's able to monitor, measure, and assess misdiagnoses. When the program is fully launched, it will scan EHRs to spot patients who have been misdiagnosed or are at risk of misdiagnosis based on a set of clinical criteria, such as a CT scan without documented follow up or an ED admission within 48 hours of hospital discharge. The program will then flag those EHRs for review and, if necessary, further action.

Hardeep Singh—Safer Dx project lead at Geisinger, chief of health policy, quality, and informatics at the Michael E. DeBakey VA Medical Center, and associate professor at Baylor College of Medicine—said of the initiative, "Knowledge from systematically analyzing missed opportunities in correct or timely diagnosis will inform improvements and create a learning health system for diagnosis."

Geisinger also plans to seek additional strategies for reducing misdiagnoses from both providers and patients. Providers will be able to call in to a confidential hotline to leave messages on recommended process and system improvements for curbing misdiagnoses that will then be assessed by the Safer Dx program, Landro reports.

2. The Human Diagnosis Project

Another initiative aimed at curbing misdiagnoses is the Human Diagnosis Project, or Human Dx, Landro writes, which uses artificial intelligence to synthesize diagnoses from multiple physicians into one cohesive recommendation. Specifically, the AI-assisted electronic consulting system allows doctors to enter information about a patient andsolicit feedback from other providers. The system then assesses and organizes the input, weighing it by the relative expertise of each doctor.

More than 6,000 doctors from 500 different organizations and 40 different medical specialties have been contributing to the system since 2014, Landro reports. And researchers at Johns Hopkins, the University of California-San Francisco, and Harvard Medical School are assessing the program's performance, expense, and potential value for training purposes.

According to Shantanu Nundy, a primary care doctor at Mary's Center and the director of Human Dx's not-for-profit arm, the goal of the program is "not only to deliver the best possible diagnosis for the patient at hand, but to form a record that doctors can draw on for similar cases in the future." Ultimately, the program if successful could expand accessibility to medical expertise, particularly for patients who might otherwise lack access to a specialist, Landro reports.

3. Brigham's new network

Sharing knowledge is the centerpiece of an initiative by Brigham and Women's Hospital, the Harvard-owned malpractice insurer Crico, and the second-opinion service Best Doctors. They have banded together to establish a network that aims to use EHRs to identify, assess, and categorize diagnostic errors and delays, particularly for primary care.
The network—called Primary Care Research in Diagnostic Errors, or Pride—plans to use forums, journals, newsletters, and webinars to share the information gathered among stakeholders. It also aims to advance the development of screening tools to help clinicians avoid misdiagnosis, curb unnecessary testing, and identify "diagnostic pitfalls," such as when a physician thinks an identified illness is responsible for new symptoms. The program also aims to educate patients about the importance of follow up.

4. University of Pittsburgh's novel medical education curriculum

To help new doctors anticipate and address misdiagnosis, the University of Pittsburgh Medical Center (UPMC) has compiled a series of videos for medical students featuring actors posing as patients, expert commentary, animation, and question-and-answer segments.

According to Landro, the videos aim to foster clinical reasoning skills and also make students aware of the prevalence and ramifications of misdiagnosis. For instance, the videos highlight the importance of asking good questions when collecting a patient's medical history so as to avoid relying on assumptions or shortcuts based on past cases.

William Follansbee, director of the UPMC Center for Medical Decision Making and a professor of cardiovascular medicine, said, "These might seem like common, simple questions we all know, but they are frequently overlooked" (Landro, Wall Street Journal, 9/12).

Why the EHR life cycle is just like raising a child

 Why the EHR life cycle is just like raising a child

A successful EHR system requires budget, resources, and planning—not only before it goes live, but after as well.

In fact, the process of implementing, deploying, maintaining, and optimizing an EHR system is similar to that of raising a child—each stage of the process requiring a unique subset of people to ensure its success. Learn more about the seven stages of the EHR life cycle in this infographic.

Get the Infographic

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