Transfers/referrals

עמוס קאהן ד'ר cahan_a at MAC.ORG.IL
Sun Jan 7 13:57:28 UTC 2018


Dear Ed,

Indeed some physicians deny needing help but the reasons for the failure of diagnosis support systems go far beyond the psychology of doctors.
The performance of available systems is limited. Maintaining a complete knowledge base is challenging, resulting in that a considerable number of conditions remains uncovered. The reduction of the clinical picture to a uni-dimensional vector of findings limits specificity and makes the differential list generated by such systems too long to be clinically useful. Moreover, available systems do not support the need of physicians to consider diagnosis base rate when constructing the differential. Poor alignment with physician workflow is another limitation of current systems, and the use of NLP to automatically extract findings, where available, reduces performance.
See https://www.jmir.org/2017/3/e54/ for a more complete review of the limitations of diagnosis support system and for ideas how to overcome them.

Amos

Amos Cahan, MD
Director of Medical Informatics
Maccabi Healthcare Services
27 Hamered St.
Tel-Aviv 68125
Israel
cahan_a at mac.org.il<mailto:cahan_a at mac.org.il>
+972-3-746-2997



From: Edward Hoffer [mailto:ehoffer at GMAIL.COM]
Sent: Saturday, January 06, 2018 5:36 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Transfers/referrals

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<mailto: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<mailto:amy at xenergyhealth.com>
312-965-9573<tel:(312)%20965-9573>

On Fri, Jan 5, 2018 at 5:52 PM, robert bell <0000000296e45ec4-dmarc-request at list.improvediagnosis.org<mailto: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<mailto: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<mailto: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.

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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 at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

**********************************************************************************************
IMPORTANT: The contents of this email and any attachments are confidential. They are intended for the 
named recipient(s) only.
If you have received this email in error, please notify the system manager or the sender immediately and do 
not disclose the contents to anyone or make copies thereof.
*** Symantec scanned this email for viruses, vandals, and malicious content. ***
**********************************************************************************************

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

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

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20180107/4102bb77/attachment.html>


More information about the Test mailing list