[Marketing] RE: [IMPROVEDX] [Marketing] Re: [IMPROVEDX] Fwd: Coverys report on diagnostic errors

Jackson, Brian brian.jackson at ARUPLAB.COM
Thu Mar 22 14:38:43 UTC 2018


I think the main opportunity here is in the word “Team”.  Healthcare desperately needs better diagnostic teamwork.  I don’t mean to imply that it’s always bad everywhere.  But radiology and pathology have become structurally less integrated into care team decisionmaking over the years.  Bob Wachter has a great chapter on the radiology problem in his book The Digital Doctor, and suggests that healthcare information systems are at least part of the problem.  Mike Laposata is a pathologist (actually department chair) down at UT Galveston, and has done a lot of work developing pathology-centered diagnostic management teams.  Essentially he’s had to create his own workflow and communication mechanisms that go around certain aspects of the EHR.

Having said all that, you might be on to something.  Categorizing into 5 grades of risk might be more feasible than trying to cram everything into 2 (normal versus abnormal).  And maybe this would help the clinician to prioritize his/her review time.  The gatekeeper will need to be the treating clinician; pathologists and radiologists don’t have enough context and are too far from the patient to make those decisions.

--Brian
From: Nelson Toussaint [mailto:ntoussaint at tamarac.com]
Sent: Thursday, March 22, 2018 7:32 AM
To: 'Society to Improve Diagnosis in Medicine'; Jackson, Brian
Subject: [Marketing] RE: [IMPROVEDX] [Marketing] Re: [IMPROVEDX] Fwd: Coverys report on diagnostic errors



March 22, 2018
8:50 AM
Brian

I am a retired Aerospace Executive that has done a lot of work in the Safe Flight arena.  When an analyst does a review of potential failures of a system, they are required to categorize them into 5 areas related to flight safety (according to his/her knowledge and experience):

A  Catastrophic
B  Hazardous
C  Major
D  Minor
E  No Effect on flight safety

It is then the responsibility of the design/operations Team to review the critical cases and respolve issues.  Sometimes this results in reclassification because the analyst did not have full understanding of the system and secondary functions; sometimes it requires accommodating the fault; sometimes it requires redesign to eliminate the failure.

The data is often very volumous, so it becomes important to focus on the critical (to flight safety) issues.

Most importantly, there is a high level gate keeper that determines which of the A, B, C faults are permitted (after Team resolution).  The gatekeeper must put his/her signature on the conclusion report, which explains why those remaining are tolerable - taken very seriously because if any of these cause a Catastrophic situation, it comes right back to the gatekeeper.  (Obviously, nothing in category A is allowed to remain).

Although this strategy does not prevent every incident, it cleans up hundreds of them.

Could a strategy of this nature be applied to supporting functions?  As you mentioned, the analyst could structure the feedback in categories and then it becomes the responsibility of the clinician Team to determine criticallity to a particular patient.

I do not know where the gatekeeper is in the medical field?

   Nelson Toussaint

TAMARAC LLC
860-844-0199
ntoussaint at tamarac.com<mailto:ntoussaint at tamarac.com>

From: Jackson, Brian [mailto:brian.jackson at ARUPLAB.COM]
Sent: Wednesday, March 21, 2018 3:02 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] [Marketing] Re: [IMPROVEDX] Fwd: Coverys report on diagnostic errors

That request comes up all the time, but I personally don’t think it can work.  It’s just really hard to figure out what sorts of cases could be safely labelled as “no followup needed”.  A risk management mindset would likely lead to almost every case being labelled as “followup needed”, including ones with really minor findings.

I agree that communication of diagnostic findings is a huge problem and opportunity.  I just don’t think that you can solve it by asking pathology and radiology (who notably don’t have all the info on the patients) to identify reports that can be safely be left unread.  It’s sort of the same problem as when clinicians only look at chemistry and hematology results that have high/low/critical flags.  This binary approach causes you to occasionally miss important findings, and it will never work reliably.

Better, in my opinion, would be to work on the efficiency of the result review process.  It needs to be much faster and easier for a clinician to review ALL diagnostic results and decide which ones need to be read in greater detail.  The role of radiology and pathology is then to structure their results for maximum readability, with clear conclusions at the top, etc.  The role of IT/software is to make it much faster to scan results in bulk without lots of clicks, seeing what’s important, and then be able to easily zoom in on areas of interest.

--Brian Jackson

From: Tom Benzoni [mailto:benzonit at GMAIL.COM]
Sent: Wednesday, March 21, 2018 8:55 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [Marketing] Re: [IMPROVEDX] Fwd: Coverys report on diagnostic errors

As technology has occasioned these errors (There was a time when Mark would pick up the phone and tell me my patient had an abnormality on CT.) so can it be programmed to help.
*On any study mandating interpretation (Radiology and pathology come to mind, although there are many others) there is to be a mandatory field: "this study requires/does not require followup". This will activate a tickler cascade that is not stopped until action is taken.
Coding this would be a minor undertaking.
So why does it not exist?
tom

On Wed, Mar 21, 2018 at 9:29 AM, Mark Graber <Mark.Graber at improvediagnosis.org<mailto:Mark.Graber at improvediagnosis.org>> wrote:
And its not just America.  Here is a report on claims data (2000 incidents) in Australia collected by Avant.  Diagnostic errors were the second leading cause for a claim in this compilation.  Cancer and cardiovascular conditions were the #1 and #2 problem areas, as in reports from the US.

https://www.avant.org.au/diagnostic-error-claims/<https://clicktime.symantec.com/a/1/A5eH3PfTLnK2PKF1gyRwVPqtQToq_Cp99veTfjImm3Q=?d=bbEnrWSRZceP1deDrf6vYEoVEIa5mp1gro9RlgmkIvHgpCtnrpMmoqQnqLxGs6pBjCbxbXjSMCB25CUADY5UvvHsBlSwxuJ1B-qmOA_YnsYhLhl_WEkEhbkgwmyQMnrK5WJVf_2p8JTmA7f2DvtTQ33THcSFfdY8WM0a4Jjdma3lLSzTmtmwmQkct3RY4Cs8BFhyBjoMq98IbtZWIKwqlXpJBd7AMCv0qAxPlxQTMyaEoTbiJ7TaJ_EuJaZRkBsCu7h73VIAVaKdF-bB6hcHupnDdmJELr3KDlHPsO6_H7Jcy0mA6ccOc-doFfthgMifz2AMKnpYWRzqHyrZjfwATmxQ1aKOvQT6LiS0_d2WXdMxVbYHGa0y_UmnZIYHo2YWwvOocTN9tVs7QQf6HQz1QHS1uZXpDjK-U6EuVyNp76ONuRxx4ve3Df9Hg20tgzFOG38JL4h9RVdnBQ%3D%3D&u=https%3A%2F%2Fwww.avant.org.au%2Fdiagnostic-error-claims%2F>


Mark L Graber MD FACP
President, SIDM
Senior Fellow, RTI International
Professor Emeritus, Stony Brook University
[cid:image001.jpg at 01D3C1B7.A882D9C0]




From: David L Meyers <dm0015 at COMCAST.NET<mailto:dm0015 at COMCAST.NET>>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, David Meyers <dm0015 at comcast.net<mailto:dm0015 at comcast.net>>
Date: Tuesday, March 20, 2018 at 12:37 PM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Fwd: Coverys report on diagnostic errors

To the List, Coverys, the medical liability insurer has issued a report on diagnostic errors.  You can download the PDF here.
https://coverys.com/PDFs/Coverys_Diagnostic_Accuracy_Report.aspx<https://clicktime.symantec.com/a/1/rRonm13cCh4U1ceRO5c6sa-7oSKsK9apz_lnaIx-Y6E=?d=bbEnrWSRZceP1deDrf6vYEoVEIa5mp1gro9RlgmkIvHgpCtnrpMmoqQnqLxGs6pBjCbxbXjSMCB25CUADY5UvvHsBlSwxuJ1B-qmOA_YnsYhLhl_WEkEhbkgwmyQMnrK5WJVf_2p8JTmA7f2DvtTQ33THcSFfdY8WM0a4Jjdma3lLSzTmtmwmQkct3RY4Cs8BFhyBjoMq98IbtZWIKwqlXpJBd7AMCv0qAxPlxQTMyaEoTbiJ7TaJ_EuJaZRkBsCu7h73VIAVaKdF-bB6hcHupnDdmJELr3KDlHPsO6_H7Jcy0mA6ccOc-doFfthgMifz2AMKnpYWRzqHyrZjfwATmxQ1aKOvQT6LiS0_d2WXdMxVbYHGa0y_UmnZIYHo2YWwvOocTN9tVs7QQf6HQz1QHS1uZXpDjK-U6EuVyNp76ONuRxx4ve3Df9Hg20tgzFOG38JL4h9RVdnBQ%3D%3D&u=https%3A%2F%2Fcoverys.com%2FPDFs%2FCoverys_Diagnostic_Accuracy_Report.aspx>

Art Papier MD
CEO VisualDx
Associate Professor of Dermatology and Medical Informatics
University of Rochester College of Medicine

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