Transfers/referrals

Edward Hoffer ehoffer at GMAIL.COM
Sat Jan 6 03:36:20 UTC 2018


Diagnostic decision support systems (DXplain, ISABEL and VisualDx are the
big three widely available) have been clearly proven to improve the
differential diagnosis when used. The problem is that physicians as a whole
do not recognize when they need help!
I feel very strongly that the way forward is to use natural language
processing to pull key findings from the electronic records and feed these
into a decision support system. When an important diagnosis is supported
but has not been mentioned by the clinician, a reminder should be sent.
Would be glad to discuss this further off-line
Ed
Edward P Hoffer MD, FACP, FACC
Associate Professor of Medicine, part-time, Harvard

On Fri, Jan 5, 2018 at 9:11 PM, Amy Bergau <amy at xenergyhealth.com> wrote:

> This is a broad question, but opening up to the group; Evidence has shown
> that the current EMR functionality is not helping diagnosis.  What
> technology solutions could be developed to help solve these issues? Is it
> an algorithm that accesses data from the EMR? What are the best areas to
> target?
>
> Amy M. Bergau
> Founder, CEO
> amy at xenergyhealth.com
> 312-965-9573 <(312)%20965-9573>
>
> On Fri, Jan 5, 2018 at 5:52 PM, robert bell <0000000296e45ec4-dmarc-
> request at list.improvediagnosis.org> wrote:
>
>> Dear Tom,
>>
>> Strong words. But much of what you say resonates.
>>
>> What is the way forward?
>>
>> What can we do as Physicians/HCPs to create change?
>>
>> Can we borrow ideas from other countries?
>>
>> How dependent are accurate diagnoses to a background of dysfunction that
>> seems to or may exist in many hospitals?
>>
>> Do we leave it to patients? But how do they get the information to
>> understand that there is, or maybe, a problem.
>>
>> Rob Bell, M.D.
>>
>>
>>
>>
>> On Jan 5, 2018, at 8:35 AM, Tom Benzoni <benzonit at GMAIL.COM> wrote:
>>
>> Front line thoughts, interdigitated:
>>
>> On Thu, Jan 4, 2018 at 10:24 PM, robert bell <
>> 0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
>>
>>> Is there a problem in medicine regarding diagnoses and other errors in
>>> medicine when a patient gets transferred from one Physician/HCP to another,
>>> in or out of hospital?
>>>
>>> Some difficulties:
>>>
>>>    - One or more specialists are outside the computer system of the
>>>    other.
>>>
>>> We have 2 major systems in town using 2 different systems. We
>> communicate by fax...which are hundreds of printed pages of
>> indistinguishable babble. Their so much data I can't find information.
>>
>>>
>>>    - When the physician/HCP does not usually comment on diagnoses and
>>>    treatment of another, or even review what is happening to the patient on a
>>>    daily basis. This even when they *have* access to the computer
>>>    story.
>>>
>>> While some think we have diagnoses in the computer system, what is
>> actually presented is the terms used for billing; the terms used for
>> diagnoses are markedly different. There no fora (like we once had in the
>> doctors' lounge) for the disparate limited-filed physicians to
>> meet/discuss.
>>
>>>
>>>    - There is a culture of non-interference.
>>>
>>> Each stick solely to their field, for sure. And with the demise of the
>> primary care physician, we now have 5 blind men and an elephant.
>>
>>>
>>>    - When there is an important error in the computer system that is
>>>    immensely difficult to remove. E.g. “The patient has disseminated
>>>    carcinoma,” when it is not true. The error repeats time an time again with
>>>    differing results.
>>>
>>> I have a button where I can cut and paste forward all past errors.
>> However, I don't need to; this is done automatically for me, which
>> increases reimbursement to the hospital.
>>
>>>
>>>    - When there are *many* specialists involved in a patient’s care who
>>>    are not talking to each other, directly, by phone or computer and watching
>>>    the diagnoses and treatments unfold.
>>>    - Etc. etc.
>>>
>>> One would ask what needs to be done? Are there barriers that need to be
>>> broken and new procedures adopted?
>>>
>>
>> The solution is really simple; stop paying for it! The behaviors I see
>> every day (or, tonight) are as lucrative as they are dysfunctional.
>> If the end-users had a vote and that vote was directly tied to $ to
>> vendors, this behavior would cease within 24 hours.
>> There is a reason retailers have return policies; it's good for business
>> and the vendors get feedback on the quality (or lack thereof) from the
>> end-users. We do not have that in healthcare. And the pressure to change
>> will diminish as newly minted physicians believe this dysfunction is normal.
>>
>>>
>>> Do we leave as is because it is complex?
>>>
>>
>> No; can't. Interface engines can be written to unravel the Tower of
>> Babel. Chat rooms can be opened. We have the technology; we lack the will.
>> The pressure for change must come from the patient-side.
>>
>> tom
>>
>>>
>>> Rob Bell, M.D.
>>>
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>>>
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>>
>>
>>
>>
>> ------------------------------
>>
>>
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>> Medicine
>>
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>
>
>
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>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
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>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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