Errors in diagnosis and a possible way forward.

Peter Loa peterloa at GMAIL.COM
Wed Nov 28 02:14:14 UTC 2018


Information sharing is one of the best ways to reduce diagnostic errors and
unnecessary investigations.
However, as other's noted privacy issues are also important but a
significant barrier.

In Australia, although we have a single payer system, the silos between
providers are significant and the government has ran into significant
protests in rolling out a nationalised health record repository system -
https://www.abc.net.au/news/science/2018-11-14/my-health-record-opt-out-deadline-amendments-privacy-security/10481806

In other countries where privacy concerns seems to be better mitigated,
there are nationalised cloud systems for medical records
Taiwan - http://www.koreabiomed.com/news/articleView.html?idxno=4635
Korea - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141129/

Kind regards,
Peter
Medical education registrar
Mackay Hospital - Australia




On Wed, 28 Nov 2018 at 11:42, Rory Jaffe <rjaffe at chpso.org> wrote:

> California law places a roadblock in sharing information—or at least
> causes a delay. In PAHRA (Patient Access to Health Records)—health and
> safety code 123148, section f states:
>
>
>
> “(f) Notwithstanding subdivision (a), unless the patient requests the
> disclosure, the health care professional deems this disclosure as an
> appropriate means, and a health care professional has first discussed in
> person, by telephone, or by any other means of oral communication, the test
> results with the patient, in compliance with any other applicable laws,
> none of the following clinical laboratory test results and any other
> related results shall be disclosed to a patient by Internet posting or
> other electronic means:
>
> “(1) HIV antibody test, unless an HIV test subject is anonymously tested
> and the test result is posted on a secure Internet Web site and can only be
> viewed with the use of a secure code that can access only a single set of
> test results and that is provided to the patient at the time of testing.
> The test result shall be posted only if there is no link to any information
> that identifies or refers to the subject of the test and the information
> required pursuant to subdivision (h) of Section 120990 is provided.
>
> “(2) Presence of antigens indicating a hepatitis infection.
>
> “(3) Abusing the use of drugs.
>
> “(4) Test results related to routinely processed tissues, including skin
> biopsies, Pap smear tests, products of conception, and bone marrow
> aspirations for morphological evaluation, if they reveal a malignancy.”
>
>
>
> This was intended to protect patients against bad news surprises without
> first having a discussion with the doctor. Well-intended, but you can see
> the problems with translating good intentions into an inflexible law.
>
>
>
>
>
> Rory Jaffe, MD MBA, Executive Director, CHPSO <http://www.chpso.org/>
>
> 1215 K Street, Suite 930
> Sacramento, CA 95814
> rjaffe at chpso.org
> (916) 552-2600
>
>
>
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>
> *From:* Peggy Zuckerman <peggyzuckerman at GMAIL.COM>
> *Sent:* Tuesday, November 27, 2018 4:32 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Errors in diagnosis and a possible way forward.
>
>
>
> I assume that getting a single payer system in the US is not going to
> happen in the next few years or beyond.  However, one thing that could
> minimize some of the most troubling error I see in terms of diagnosis for
> cancer patients is in the failure to get reports directly to patients,
> whether labs, imaging and/or pathology.  For many years, patients have been
> told NOT to inquire as to their blood tests, and absolutely have had a
> nearly complete inability to reach those pathology and radiology reports.
> "No news is good news" has led to so many unnecessary errors, whether a
> report has gone astray or the referring physician simply misreading or
> dismissing the information in the reports.
>
>
>
> GIVE patients those reports as soon as they are available.  We can work on
> helping those patients (and their physicians) to understand the
> complexities of those.  Every patient understands the value of extra eyes
> on this kind of information, and appreciates the opportunity to prepare for
> an appointment. Those who finally see earlier reports of visible tumors,
> not 'mentioned' to them by the doctors, perhaps overlooked as the findings
> were not anticipated, or just filed before review, cannot understand why
> these reports are generally withheld.
>
>
>
> A bit of a parallel is the failure to send radiology reports to the
> patient's second opinion doctor, per their request, as the patient is
> thought to be unreliable...
>
> Peggy Zuckerman
> www.peggyRCC.com
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.peggyRCC.com&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=az90wzbh-2kQiZEIm4TRlhRC1H_oN4dx-Mj9DnjQ2oc&s=3bVcKOrAfFoas8r5jBVn5uPA8mgJch_jZhqDGwx73yY&e=>
>
>
>
>
>
> On Tue, Nov 27, 2018 at 4:10 PM mehran midia <mmidia at cogeco.ca> wrote:
>
> Hello Dr. Bell,
>
>
>
> I am a radiologist in Canada…we do have a single payer but error in
> diagnosis still happening.
>
>
>
> I think having single payers could make it easier do data mining but the
> down of single pay system is hard to implement top of the line expensive
> platform across the enterprise of health care and there is disconnect in
> provisional (State) bureaucracy.
>
>
>
> I think at heart this a data issue and how its affect decisions at
> different stages as much as it is a system and human issue.
>
>
>
> Sincerely,
>
>
>
> Mehran Midia
>
>
>
>
>
>
>
>
>
>
>
> On Nov 27, 2018, at 6:04 PM, Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
>
>
>
>
>
> Dear all
>
>
>
> I could be wrong but it seems that the problems relating to errors in
> diagnosis are so massive that any health organization/Society that tries to
> do something gets mired in the weeds with little eventually happening.
>
>
>
> It would seem that that it would be good to tackle one thing at time in a
> significant way and succeed at something.
>
>
>
> Also, the piece by Mike Posata is a good example of the influence of money
> on errors.
>
>
>
> My top three areas for research would be:
>
>    - Supporting a single payer system, like most of the developed world
>    already has, and investigating the benefits of a single payer system in
>    preventing errors in diagnosis.
>    That would remove so many hurdles we do not need in medicine. A big
>    challenge but collaboratively, I think, could be done.
>    - Identifying the very commonest errors in diagnosis in each
>    specialty, and working hard on those to prevent them - pulmonary medicine
>    would be my first.
>    - Clarifying all the issues regarding laboratory tests, including,
>    ordering, reporting, interpretation, and subsequent action.
>
> My basic message is to tackle something that is likely to produce results,
> and can be completed in a defined period of time with the available
> resources.
>
>
>
> Comments very welcome.
>
>
>
> Rob Bell, M.D.
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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