Boston Globe Medical Mystery

Amy Bergau amy at XENERGYHEALTH.COM
Tue Dec 19 03:28:47 UTC 2017


Ed and Melanie, et. al:

I'm am enjoying this dialogue.The idea I think I hear is that we should
combine* automated algorithmic review of data and pair it with patient
feedback.  *
Is the thought that we run an alogrithm on top of EMR data and then couple
this with patient reported data in some format?

I'm interested in your thoughts.

Amy Bergau
CEO, Xenergy Health

Amy M. Bergau
Principal, CXO
amy at xenergyhealth.com
312-965-9573

On Mon, Dec 18, 2017 at 7:59 PM, James Sorace <jamessorace1 at gmail.com>
wrote:

> Melanie - I very much agree with your comment. It would be desirable to
> routinely review diagnoses in a more comprehensive manner. This might
> include some combination of automated algorithmic review coupled when
> possible with patient feedback. I am a pathologist and I think we (along
> with radiology) might be able to assist in implementing these types of
> processes. One of the keys, as always, would be to learn how to balance the
> need for human intervention so it is focused on the more challenging cases
> without to many false alerts. There are many challenges. one is that we
> tend to have systems that capture diagnostic codes and check lists as
> apposed to accurately describing the patients signs/symptoms and functional
> status (thus contributing to diagnostic bias).
>
> You are also correct in that there does not appear to be much research
> that measures the effectiveness of the overall diagnostic process
> especially in a manner that promotes systematic improvement. But this may
> be able to be addressed.
>
> James Sorace MD MS
>
> On Sun, Dec 17, 2017 at 5:56 PM, Powell, Melanie A <
> Melanie.A.Powell at medstar.net> wrote:
>
>> Ed - I'm glad you brought this up. I am a member of my hospital's
>> Patient and Family Advisory Council for Quality and Safety and one of our
>> very active members sent a similar article to our group this morning (re:
>> cancer diagnosis in a young adult who was told she was too young to have
>> the diagnosis).
>>
>> It would be very interesting to do a study (retrospective or prospective)
>> asking patients if they raised a concern to their provider about an
>> alternate diagnosis and whether this concern was heeded, then perform chart
>> review to see if physicians who heed patient concerns: 1) refer for second
>> opinion or 2) broaden their differential (in whatever form) diagnose more
>> accurately and faster. [If this study has been done - please share!]
>>
>> We've discussed the challenge of balancing diagnostic accuracy vs.
>> diagnostic stewardship. We've also discussed the challenge of bias and
>> heuristics on the cognitive process. Ed - while you were able to
>> successfully guess the diagnosis, as you mention you had the slight
>> advantage of knowing it was an obscure disease. How do we create these
>> flags for ourselves (in the EHR or via CDS tools) to bolster the cognitive
>> process so we don't have to rely on hindsight to learn how we might have
>> gotten to the correct diagnosis?
>>
>> At the DEM conference in October, Kaiser Permanente Southern
>> California group mentioned an EHR (Epic) based "second opinion" messaging
>> service to specialists from PCPs for urgent or routine feedback. I wonder
>> how many of these programs exist, at what rate these consults result in a
>> confirmed or new diagnosis, and whether merely having the option of a
>> reliable second opinion broadens a physician's differential. It would also
>> be interesting to routinely perform "second opinion chart audits" to
>> determine the rate of near miss diagnostic error events (i.e. delayed or
>> missed diagnosis that was caught via chart audit prior to patient harm).
>> Does anyone know of a study like this (being undertaken or previously
>> published)?
>>
>> Melanie Powell, MD/MPH
>> Fellow, MedStar Institute for Quality and Safety
>> (c) 410-688-5216 <(410)%20688-5216>
>> Website: http://www.medstariqs.org/
>>
>> ------------------------------
>> *From:* Edward Hoffer [ehoffer at GMAIL.COM]
>> *Sent:* Sunday, December 17, 2017 3:49 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] Boston Globe Medical Mystery
>>
>> Today's Boston Globe had a special magazine on medical issues. Lead
>> story, on P2, is a dramatic story of a young man whose debilitating illness
>> took 8 years to be diagnosed. Clued strongly by the fact that this was an
>> obscure disease, I guessed it after reading the first paragraph. More
>> importantly, putting the symptoms from the first paragraph and one from the
>> third into both DXplain and Isabel gave the diagnosis (#1 on DXplain list,
>> #7 and red-flagged on Isabel's)
>> When will such "second opinions" become mandatory?
>> Ed
>> Edward P Hoffer MD, FACP, FACC
>>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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