Friday, October 14, 2011

Diagnostic Errors Are A Problem That Needs To Be Addressed. Here Is One Type of Approach.

The following popped up the other day.

Study sheds light on docs' perspectives on curbing diagnostic errors

October 04, 2011 | Molly Merrill, Associate Editor
WALTHAM, MA – A new study finds that physicians believe that preventing diagnostic errors can be aided using technology like decision support and artificial intelligence, but they will never replace the physician’s role in diagnosis.
The 6,400-clinician study was conducted by QuantiaMD, which touts itself as the largest mobile and online physician community.
Key findings of the study include:
  • 47 percent of the respondents encounter diagnostic errors (e.g., missed, late, or wrong diagnoses) at their practice at least monthly.
  • 64 percent said that up to 10 percent of misdiagnoses they have experienced have directly resulted in patient harm.
  • More than 96 percent of clinicians believe diagnostic errors are preventable at least some of the time.
Study respondents identified atypical patient presentation, failure to consider other diagnoses and inadequate patient history as the top contributors to diagnostic errors. Respondents also noted external factors such as over-testing to avoid malpractice risk.
Clinicians indicated the top five diagnoses at greatest risk for misdiagnosis as:
  • Pulmonary embolism
  • Bipolar disorder
  • Appendicitis
  • Breast cancer
  • Myocardial infarction
An estimated 40,000 to 80,000 US hospital deaths result from misdiagnosis annually, according to a 2002 JAMA article. However, these errors have received little attention due to a combination of under-reporting and under-developed measurement techniques. QuantiaMD's Do No Harm Special Interest Group initiated this study to shed light on this problem and to engage the nation's physicians in a mobile and online interactive educational program aimed at helping to prevent these errors.
"Diagnostic errors have been a long-neglected aspect of the patient safety movement, not getting the attention they deserve," said Robert M. Wachter, MD, professor and associate chairman, Department of Medicine, University of California, San Francisco and the moderator of the new series. "This QuantiaMD program, which includes presentations by many of the world's leading experts on diagnostic mistakes, lays the foundation for physicians to come together to begin discussing the challenge of improving our diagnostic acumen, and learning about the utility of new tools, including new kinds of cognitive training, systems-based decision support tools, and even artificial intelligence."
.....
QuantiaMD's 8-part series, "Preventing Diagnostic Errors", is available for viewing here. In it, Wachter and his faculty of experts from across the nation discuss the latest thinking around misdiagnosis, including current and future approaches to overcome many of the challenges identified in this study and elsewhere. Each interactive segment takes on a different aspect of the issues, such as exploring systems and cognitive errors, focusing on improving diagnostic reasoning, and discussing policies and future approaches to prevention.
More here:
The full press release on which this article is based is found here:
A 12 page report on the study is found here:
I think it is fair to say the view of the physicians surveyed was that while computers can help, there is still some art to diagnosis that is hard to replicate using technology.
It is worth noting that it is well recognised that missed and wrong diagnoses are a really very serious issue and need to be addressed comprehensively for the sake of all concerned.
Quantia have a program to encourage error prevention which is obviously a good idea!
In this regard it is interesting that IBM have deployed their AI technology used to play Jeopardy to address the issue as its first real task!
Also worthy of mention is Isabel - which is a diagnostic decision support tool with a pretty good reputation. You can visit their web site here:
I suspect this area is a topic we are going to hear more about in coming years.
David.

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