IOM report-Great impact but important omissions
Jason.Maude at ISABELHEALTHCARE.COM
Fri Sep 25 11:18:53 UTC 2015
The IOM report has given our cause a massive and powerful boost. This was an inspired move by SIDM, Mark et al!
It is a fantastic and comprehensive report and certainly bold in stating that the problem needs to be addressed urgently and calling it a 'moral imperative' to address the issue. The jumbo jet crash a day image of the “To Err is Human” report was replaced by the idea that most of us would suffer a dx error in our lifetime. If it does nothing else but get the healthcare industry to focus on the issue and start to do something about it then it will have done a great service to millions of patients for years to come. However, I feel there were some important omissions:
* If we are to fully capitalise on the attention and momentum created we must, as a matter of urgency, come up with a measure which can be used now. The report described the many efforts at coming up with measures and all the problems associated with each one. If we carry on along this path it will be another 5-10 years before we have a practical measure and we may well have lost the momentum just created. The report did suggest that EMRs should provide a space to contain a differential diagnosis but did not go on to consider the documenting of a differential diagnosis as a potential measure which could be introduced fairly quickly. You can read more on this suggestion in the 1st issue of ‘Diagnosis' http://www.degruyter.com/view/j/dx.2014.1.issue-1/dx-2013-0009/dx-2013-0009.xml?format=INT
* The report was also light on the current impact of IT and decision support tools. The problem with relying on peer reviewed published evidence when looking at IT is that it is already several years out of date. IT changes quickly and I believe that the committee would have benefitted from seeing these tools in action at some of the hundreds of institutions using them daily. Diagnostic decision support tools are not “relatively new” as have been available since the 1980s!
* The report also missed looking more at time to diagnosis and expanding on the promising research covering the time to diagnosis of mainly cancers so far. It would be good to know, and frankly seems quite basic, what the average time to diagnosis is for a range of diseases so at least we could establish when there has been a delay.
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