Definition of Diagnosis

Bob Swerlick rswerli at GMAIL.COM
Sun Feb 5 18:12:38 UTC 2017


I think this perspective is spot on. Diagnoses are always provisional to
some degree but our billing processes are require us to commit to a
diagnosis before we should be committing.

This functionality may already be present. Our EHR (Cerner Powerchart)
actually has modifiers regarding diagnoses - possible, probable, confirmed,
etc that come up when a diagnosis is selected for billing. No one uses them
(except me), probably because of training and time issues.

Bob

On Sun, Feb 5, 2017 at 9:55 AM, Twest54973 <
000000040134e744-dmarc-request at list.improvediagnosis.org> wrote:

> This question is for the Board of Directors at SIDM:
>
> Can SIDM approach ONC at the federal level to ask ONC to make a formal
> comment about the dynamic aspects of the dx process as we have previously
> described in prior emails and then start a conversation with the EMR vendor
> community to have them modify their platforms to incorporate the evolving
> nature of any given dx?
>
> ADDING prelimary/presumed/confirmed  codes for ICD-11 (i dont know when
> that will be done) with the WHO would be a whole different process ...
>
> Tom
>
> Thomas Westover MD
> Cooper Medical School
>
>
> Sent from my iPhone
>
> On Feb 5, 2017, at 2:06 AM, Ted.E.Palen at KP.ORG wrote:
>
> Great conversation
> I often cannot make a diagnosis the first time I see a patient. In fact it
> may take many visits, testing, and cogitation to arrive at the diagnosis
> that fits all the facts and even then it may be wrong.
> Early on in this process I am often frustrated by the need to "code" a
> diagnosis. Early on I may not know the diagnosis but if forced to code on
> it may often be in error. I sometimes resort to just coding the most
> pertinent symptoms (but the business people do not like that). It would be
> much better if our coding systems would allow for coding "preliminary" or
> "working" or "presumed" and finally "confirmed." But alas we are not, we
> are not allowed a coding system that is clinically relevant but rather the
> owners of the system profit from a coding billing system. Until this
> changes we will be forced to use inadequate means to document (and hence an
> inadequate means to measure) diagnostic reasoning.
>
> Ted E. Palen, PhD, MD
> Institute for Health Research
> Colorado Permanente Medical Group
> Denver, CO
> 303-614-1215 <(303)%20614-1215>
>
> On Jan 19, 2017, at 9:06 AM, Charlie Garland - The Innovation Outlet <
> cgarland at INNOVATIONOUTLET.BIZ <cgarland at innovationoutlet.biz>> wrote:
>
> *Caution: *This email came from outside Kaiser Permanente. Do not open
> attachments or click on links if you do not recognize the sender.
> ------------------------------
> Tom, I understand your perspective and you make an excellent point.  That
> said, it's all the more reason to collectively include that very
> perspective in any "standard" definition of Dx Error.  I heartily agree
> with the *dynamic *nature of the Dx process, and that explicitly
> including something akin to a "confidence interval" is not only
> appropriate, but would facilitate any physician's dilemma in having to make
> an either-or choice between a right and a wrong answer (e.g. one option
> would be to add a "confidence interval" field into the EMR, which could
> serve as a trigger/forcing strategy; I'm sure there are others).
>
> Some would tend to simply stick with the definition that we've currently
> been handed by IOM, seemingly suggesting "if it ain't broke, don't fix it."
>  Well, have a look at the outcomes data.  *It's broke*.
>
> While I would still advocate for a conscious recognition of the concept of
> "completeness" (i.e. don't stop exploring, just because you've found one
> answer), I do believe you're onto something very interesting and worth us
> all re-thinking.
>
> Charlie
> =================================================
>
> Charlie Garland
> Senior Fellow of HITLAB <http://www.hitlab.org> (Healthcare Innovation &
> Technology Laboratory @ Columbia University Medical Center)
>
> -------- Original Message --------
> Subject: Re: [IMPROVEDX] Definition of Diagnosis Error
> From: Twest54973
> <000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> Date: Wed, January 18, 2017 6:29 pm
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> Dr Garland
>
> I must respectfully disagree ...
>
> Because EVERY dx a clinician makes is inherently an incomplete hypothesis
> that is not "completed" until the pt is followed serially over time to
> evaluate the pts response to a proposed therapeutic intervention(s)
>
> Diagnoses are not static objects : they  evolve over time by definition
>
> Perhaps It would be more relevant and truthful (and perhaps more easily
> measurable?) to classify diagnoses as preliminary, presumed, and
> probable/final as the clinician moves from less certainty to more certainty
> thru these three blurred stages  (as more data is gathered and the clinical
> course becomes more revealing )
>
> One could then compare the time course , appropriateness of testing
> strategies and accuracy between clinicians by each category
>
> Just a thought ...
>
> Tom Westover MD
> Cooper Medical School
> Camden NJ
>
>
>
> Sent from my iPhone
>
> On Jan 18, 2017, at 3:55 PM, Charlie Garland - The Innovation Outlet <
> cgarland at INNOVATIONOUTLET.BIZ> wrote:
>
> Great question, Bob.  But I would ask a follow-up question to yours...
>
> What qualifies something as being "SIDM-approved"?  Is this a result of a
> democratic vote?  If so, by all members, by a steering committee, and/or by
> some other group herein?  I recall that Mark Graber openly invited feedback
> from the audience at the Sep 2015 conference (just after the IOM report was
> published) on these definitions, and he got a few suggestions in real time,
> but I don't know what happened thereafter.
>
> One suggestion I have is to supplement these three dimensions (*wrong*,
> *missed*, and *delayed*) with that of *incomplete*.  Perhaps there is
> more, but in my mind, "incomplete" is a unique form of Dx error that is not
> necessarily captured by any of the other three.  One could argue that it's
> merely a form of missed Dx, but to lump it in to that category would lose a
> crucial nuance of the physician's cognitive process (e.g. it would tend to
> obscure an important cognitive bias at play in such cases).  There's much
> more than just this example, but for brevity sake, I'll end there.
>
> Happy to elaborate/discuss further for anyone's interests...
>
> CG
>
> =================================================
>
> Charlie Garland
>
> Senior Fellow of HITLAB <http://www.hitlab.org> (Healthcare Innovation &
> Technology Laboratory @ Columbia University Medical Center)
> Member of the Board of Trustees at Creative Education Foundation
> <http://www.creativeeducationfoundation.org/>
> Developer of Cognitive Buoyancy <http://www.cognitivebuoyancy.com/> ("The
> Trigger to Innovation")
>
>
>
>
>
> -------- Original Message --------
> Subject: Re: [IMPROVEDX] Definition of Diagnosis Error
> From: Tom Benzoni <benzonit at GMAIL.COM>
> Date: Wed, January 18, 2017 11:17 am
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
> There are too many flaws in the definition to give it credibility.
>
> Tom
>
> On Jan 18, 2017 8:33 AM, "Bob Latino" <blatino at reliability.com> wrote:
>
>> Is this IOM Definition of Diagnosis Error an accepted definition by SIDM?
>>
>> What is Diagnostic Error?
>> The Institute of Medicine recently defined diagnostic error as the
>> failure to (a) establish an accurate and timely explanation of the
>> patient’s health problem(s) or (b) communicate that explanation to the
>> patient. Simply put, these are diagnoses that are missed altogether, wrong,
>> or should have been made much earlier.
>>
>> These categories overlap, but examples help illustrate some differences:
>> *A missed diagnosis *refers to a patient whose medical complaints are
>> never explained. Many patients with chronic fatigue, or chronic pain fall
>> into this category, as well as patients with more specific complaints that
>> are never accurately diagnosed.
>>
>> *A wrong diagnosis* occurs, for example, if a patient truly having a
>> heart attack is told their pain is from acid indigestion. The original
>> diagnosis is found to be incorrect because the true cause is discovered
>> later.
>>
>> *A delayed diagnosis* refers to a case where the diagnosis should have
>> been made earlier. Delayed diagnosis of cancer is by far the leading entity
>> in this category. A major problem in this regard is that there are very few
>> good guidelines on making a timely diagnosis, and many illnesses aren’t
>> suspected until symptoms persist, or worsen.
>>
>>
>> *Robert J. Latino, CEO*
>> Reliability Center, Inc.
>> 1.800.457.0645 <(800)%20457-0645>
>> blatino at reliability.com
>> www.reliability.com
>> <image001.jpg>
>> <https://www.linkedin.com/company/958495?trk=tyah&trkInfo=clickedVertical%3Acompany%2CclickedEntityId%3A958495%2Cidx%3A1-1-1%2CtarId%3A1464096807851%2Ctas%3Areliability%20center%2C%20inc.>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBE
>> D1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST
>> .IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>
>
> ------------------------------
>
> Address messages to: IMPROVEDX@ <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?
> SUBED1=IMPROVEDX&A=1 or send email to: IMPROVEDX-SIGNOFF-REQUEST@
> LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/




-- 
Bob Swerlick






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20170205/4a85d3a0/attachment.html>


More information about the Test mailing list