[EXTERNAL] [IMPROVEDX] What comes first

Bob Latino blatino at RELIABILITY.COM
Tue Mar 14 15:49:07 UTC 2017


Thanks Ross,

Is the AHLA who you may be thinking of (https://www.healthlawyers.org/Pages/home.aspx)?  I can check.

Typically, when a case goes to verdict, the evidence tends to get polarized (to a degree) to accommodate each party's case.  This is just how our justice system works, but such polarization exists when there is an eventual winner and loser.

In safety investigations, the goal is a bit different and that affects how evidence is treated.  The goal of a safety investigation is to understand the systems that failed the decision-maker, thus contributing to the bad outcome.  The 'system deficiencies' that affected reasoning is where the gold is.  The evidence 'is what it is' and the results 'are what they are'.

However, admittedly and unfortunately, most RCA's are weak when they get into the human performance issues, due to a lack of knowledge by the analysts about the human sciences.  Such analyses get 'fuzzy' when they get inside of one's brain.  It is easy to stop short of this cognitive understanding of reasoning, and run with more concrete findings and will typically still be acceptable to the receiving department or regulatory agency.

Even knowing the higher level of types of Dx Error that make it to the legal system would be helpful.

I have some friends who are members of AHLA, I will ask for their assistance.  Thanks.

Bob Latino

Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com
www.reliability.com
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From: Koppel, Ross J [mailto:rkoppel at sas.upenn.edu]
Sent: Tuesday, March 14, 2017 11:08 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG; Bob Latino <blatino at reliability.com>
Subject: Re: [EXTERNAL] [IMPROVEDX] What comes first


there's an association of healthcare attorneys who has that info.







Ross Koppel, PhD, FACMI

UNIVERSITY OF PENNSYLVANIA

Sociology Dept;  LDI Senior Fellow, Wharton; &

Affil Fac. Sch. of Medicine.

Chair, AMIA Clinical Information Systems Working Group.

Ph: 215 576 8221; Cell 215 518 0134



________________________________
From: Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>
Sent: Tuesday, March 14, 2017 10:49 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] What comes first


Does anyone know the % of overall diagnoses, that involve 'misdiagnosis' [as defined by a claimant), that result in a claim that is either settled or lost to verdict?



Of that likely small %, is there data typically collected from such individual cases and fed into some type of national database, to show more details about the type and nature of the 'misdiagnosis'?  Similar to the concept that acute care facilities feed their RCA's into a PSO where the information is protected from discovery, but trended nationally.



I guess I seeking to see if any trending data is collected to find commonalities on the most frequent types of Dx errors that result in the worst outcomes?



Robert J. Latino, CEO

Reliability Center, Inc.

1.800.457.0645

blatino at reliability.com<mailto:blatino at reliability.com>

www.reliability.com<http://www.reliability.com>







-----Original Message-----
From: Ruth Ryan [mailto:ruth at RYAN-GRAHAM.COM]
Sent: Tuesday, March 14, 2017 8:58 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] What comes first



Guidelines achieve closest rapprochement when the evidence piles high.



The weaker or less developed the evidence, the more variation and disagreement.



-----Original Message-----

From: Hamm, Robert M. (HSC) [mailto:Robert-Hamm at OUHSC.EDU]

Sent: Monday, March 13, 2017 4:25 PM

To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] What comes first



There are guidelines on making guidelines.

https://cebgrade.mcmaster.ca/guidecheck.html

Maybe if one paid attention to whether the guidelines had been produced with due attention to the quality of evidence supporting them, there would be less of a problem of "conflicting guidelines" and eventually, more clinician willingness to be aware of guidelines and adhere to them (most of the time).



Rob Hamm





-----Original Message-----

From: Samuel, Rana [mailto:Rana.Samuel at VA.GOV]

Sent: Monday, March 13, 2017 3:19 PM

To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Subject: Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] What comes first



The place to start would be by tidying up the guidelines themselves. What credibility do guidelines have when multiple differing guidelines exist on a topic? I believe someone on this listserve mentioned earlier that there were 6 guidelines on Atrial fibrillation, and they all had differing recommendations!



First set the standard, then promote / facilitate use of the standard!



Rana



Rana Samuel, MD, FCAP

Chief, Pathology and Laboratory Medicine Service (PALMS, 113) Lead pathologist - VISN 2 VA western New York Healthcare System (VAWNYHS)

3495 Bailey Avenue, Buffalo, NY 14215

Ph:    716-862-8701

Fax:  716-862-7824

Rana.samuel at va.gov<mailto:Rana.samuel at va.gov>



-----Original Message-----

From: Robert Bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]

Sent: Monday, March 13, 2017 11:55 AM

To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

Subject: [EXTERNAL] [IMPROVEDX] What comes first



Could I add one big item to my list to tidy up medicine, and that is the number of medical guidelines not followed by so many HCPs.



It reminds me of doing surgery today without a sterile environment as was done in the 1800s. As we learn should we not change? Does the guideline field need studying? Do computers need to remind us of critical aspects of a guideline. What is a critical aspect?



Rob Bell, MD



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