Once again, the venerable Institute of Medicine (IOM) has published an important work on healthcare and patient safety, this time on diagnostic errors. The 369-page report, "Improving Diagnosis in Health Care," released Sept. 22, found that most of us will experience a misdiagnosis in our lifetime. Five percent of U.S. adults who seek outpatient care each year experience a diagnostic error, which includes a wrong, inaccurate or delayed diagnosis; these errors contribute to about 10 percent of patient deaths, and up to 17 percent of hospital adverse events.
And not surprisingly, EHRs and health IT are front and center in the report in both a positive and a negative way.
According to IOM, EHRs are great tools that support the clinicians making diagnoses; help mitigate human limitations, such as memory or communication lapses; and provide helpful clinical decision support. They also can be used to scan for diagnostic errors both with individual patient records and in population health endeavors.
However, the report also points out that EHRs contribute to and sometimes cause diagnostic errors with poor design, poor integration into workflows and poor usability. Even clinical decision support is a double-edged sword, contributing to errors by both overreliance and overload. Lack of interoperability and EHR vendor gag clauses, which stifle discussion about patient safety issues, also are major problems contributing to diagnostic errors.
And, as usual, the IOM doesn't just report the news; it also provides helpful recommendations to the industry to reduce these errors, which will "likely worsen" unless action is taken. In addition to suggestions such as improving teamwork and increasing clinician training, the IOM suggests that:
- Health IT vendors and the Office of the National Coordinator "work together with users to ensure that technology used in the diagnostic process demonstrates usability, incorporates human factors knowledge, integrates measurement capability, fits well within clinical workflow, provides clinical decision support and facilitates the timely flow of information among patients and healthcare professionals involved in the diagnostic process"
- Vendors should meet interoperability standards to support data sharing across care settings by 2018
- The Department of Health and Human Services should require 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"
- HHS should require health IT vendors to routinely submit their products for independent evaluation and notify users about potential adverse effects on the diagnostic process related to the use of their products.
These are excellent suggestions.
So what's the problem?
It's that we've heard this before. Take a look at some of the IOM's prior reports on patient safety. In 2011, the IOM issued a report on EHRs and patient safety that made many of the same recommendations. But clearly many of them haven't been implemented, since the IOM is recommending them again.
And look at the IOM's 2012 report on better care and lower cost, which also touches on EHRs and patient safety. That barely received attention when it was first issued, let alone now.
No wonder the IOM has to repeat itself.
Note that this diagnostic error report made a splash--last week. It's already left the limelight. This week is all about ICD-10 and Meaningful Use Stage 3. One only knows what will be the next issue du jour.
And I question how much the Health IT Safety Center can help here. Its goals are more modest than what the IOM recommends, and it has little authority to effect change.
I don't want to play Russian roulette with my health. I don't want to speculate whether I've already had my once in a lifetime misdiagnosis, or whether it's yet to come.