The Institute of Medicine (IOM) is calling for better use of health information technology (IT) to help hospital’s reduce diagnostic errors, which are likely to affect every U.S. patient.
According to the recently released report, “Improving Diagnosis in Health Care,” the occurrence of diagnostic errors has been largely unappreciated in efforts to improve the quality and safety of health care and, as a result, most people will experience at least one diagnostic error, defined as delayed or inaccurate diagnoses, in their lifetime.
The IOM report estimates that 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error and diagnostic errors contribute to approximately 10 percent of patient deaths. Medical record reviews suggest that diagnostic errors account for 6 to 17 percent of adverse effects in hospitals, the report finds. And, these errors are the leading type of paid medical malpractice claims and are “almost twice as likely to have resulted in the patient’s death compared to other claims,” according to the report.
Victor Dzau, president of the National Academy of Medicine, said in a statement that the latest report was a “serious wake-up call that we still have a long way to go.”
"Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now,” Dzau said.
As it relates to health IT, the report noted that electronic health records (EHRs) can act as barriers to correct diagnoses as “auto-fill” functions can result in erroneous information being entered and EHRs often lack interoperability.
The report concluded that health IT has the potential to improve diagnosis and reduce diagnostic errors when health IT tools "support diagnostic team members and tasks" and "reflect human-centered design principles." However, the report also stated that "there have been few demonstrations that health IT actually improves diagnosis in clinical practice."
"Indeed, many experts are concerned that current health IT tools are not effectively facilitating the diagnostic process and may be contributing to diagnostic errors," the authors of the report write.
To address some of these issues, the IOM report recommends health IT vendors and the Office of the National Coordinator for Health information Technology (ONC) work together to ensure that health IT used in the diagnostic process demonstrates usability, fits well within clinical workflows, provides clinical decision support and facilitates the flow of information among patients and providers.
The IOM also calls on the ONC to require health IT vendors by 2018 to meet interoperability standards that facilitate the flow of patient information across care settings.
In addition, the report recommends that the Secretary of the U.S. Department of Health and Human Services (HHS) require health IT vendors submit their products for routine independent evaluation and notify users about potential adverse effects on the diagnostic process related to the use of their products. And, the IOM suggests that HHS require IT vendors to permit and support the free exchange of information about real-time user experiences with health IT design and implementation that adversely affect the diagnostic process.
“Diagnosis is a collective effort that often involves a team of health care professionals -- from primary care physicians, to nurses, to pathologists and radiologists,” John Ball, chair of the committee and executive vice president emeritus, American College of Physicians, said in a statement. “The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis made.”
The IOM report also recommended that health care organizations and professionals provide patients with opportunities to learn about diagnosis, as well as improved patient access to EHRs, including clinical notes and test results.
The report’s findings conclude that “diagnostic errors stem from a wide variety of causes that include inadequate collaboration and communication among clinicians, patients, and their families; a health care work system ill-designed to support the diagnostic process; limited feedback to clinicians about the accuracy of diagnoses; and a culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve.
“To improve diagnosis, a significant re-envisioning of the diagnostic process and a widespread commitment to change from a variety of stakeholders will be required,” the authors of the report state.
