It's time to care about diagnostic errors, and EMRs can help


Did you happen to catch the item in FierceHealthcare on Tuesday about diagnostic errors in medicine?

"Diagnostic errors are the outcasts of the patient safety movement. Patient safety advocates have long neglected them, giving them far less attention than adverse events such as infections and medication errors, according to an article published [Tuesday] in Health Affairs," writes FierceHealthcare's Sandra Yin.

The paper's author, Dr. Robert Wachter, professor and associate chair of the Department of Medicine at the University of California, San Francisco, is quoted as saying: "The topic of diagnostic errors has been strangely absent from the flurry of patient safety activity over the past decade." And though the September Pennsylvania Patient Safety Advisory cites diagnostic error as the No. 2 leading cause of malpractice claims and the Health Affairs article notes that 10 percent of autopsies reveal a diagnostic error that likely changed the patient's care or prognosis, Wachter says the patient safety movement tends to focus on systems of care, which often don't have much of an effect on diagnoses.

This is not news to me, nor should it be to anyone with an interest in EMRs. Dr. Larry Weed has been talking and writing for half a century about how computers can improve physicians' diagnostic thought processes. Isabel Healthcare, a company that makes diagnostic decision support software, has been trying for nearly a decade to help prevent the kinds of errors that nearly killed Isabel, the three-year-old daughter of company founder Jason Maude. It's the same kind of error that has actor Michael Douglas fighting for his life right now.

Anyone who watches the wonderfully compelling "House, M.D." should understand what happens when physicians can only make educated guesses at diagnosing rare conditions they may only see once or twice in their careers. But what gives a TV drama its excitement kills or badly harms people in the real world. It's time for doctors to stop relying on their memory in making diagnoses and let computers help.

Pity that the Stage 1 "meaningful use" rules only require providers to implement a single rule for clinical decision support. How many more people must die due to misdiagnosis? - Neil

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