[EXTERNAL] Re: [IMPROVEDX] DX measures

Tom Benzoni benzonit at GMAIL.COM
Tue Jan 29 12:28:35 UTC 2019


You guys make me feel old!
We were taught to do this routinely in the days of yore when we used stylus
and papyrus.
This became an automated exercise in increasing billings. This is now in
Electronic Billing Records in a macro that the hospital made for the scribe
to enter.
This hypothesis technique got lost when physicians lost their place at the
table. It is valuable and can be brought back by removing automation for
billing.
Tom Benzoni

On Mon, Jan 28, 2019, 22:36 Peter Loa <peterloa at gmail.com wrote:

> Maybe this discussion about differential is problematic.
> This NEJM article argues that we should be moving towards writing
> hypothesis into the notes (pdf also attached) -
> https://www.nejm.org/doi/pdf/10.1056/NEJMp1606402
> I know I would be uncomfortable writing only hypothesis in the case notes
> but maybe after writing down the primary diagnosis, other differentials
> could be written as hypotheses?
>
> Has anyone actually seen hypothesis written in the notes?
> What could be the problems in you see?
>
> Peter
> Med ed reg - Mackay
>
> On Mon, 10 Dec 2018 at 03:30, Jarrett, Mark P <MJarrett at northwell.edu>
> wrote:
>
>> It is not about a grade or being right or wrong. The problem centers
>> around critical thinking and reassessment. It is true that the ED diagnosis
>> is very symptom based. These symptoms are still important as test data
>> returns. What is needed is an iterative process that incorporates new
>> information but does not reflect earlier information. My comment on natural
>> language processing was centered on using the documented critical thinking
>> by the ED physician to assess if their differential diagnosis was
>> appropriate, the admitting physician also reevaluated and subsequent
>> providers reassessed. My fear is that checklist rich EHR has  suppressed
>> what was on paper in the past (but not often enough).
>>
>>
>>
>> Mark
>>
>>
>>
>>
>>
>> Mark P. Jarrett, MD, MBA, MS
>>
>> SVP & Chief Quality Officer
>>
>> Associate Chief Medical Officer
>>
>> Northwell Health
>>
>> Professor of Medicine
>>
>> Zucker School of Medicine at Hofstra/Northwell
>>
>> (P) 516-321-6044
>>
>> (C) 917-796-3935
>>
>> mjarrett at northwell.edu
>>
>>
>>
>>
>>
>>
>>
>> *From: *"Sanders, Lisa" <lisa.sanders at YALE.EDU>
>> *Reply-To: *Society to Improve Diagnosis in Medicine <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Sanders, Lisa" <
>> lisa.sanders at YALE.EDU>
>> *Date: *Saturday, December 8, 2018 at 2:38 PM
>> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
>> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> *Subject: *[EXTERNAL] Re: [IMPROVEDX] DX measures
>>
>>
>>
>> *External Email. Use Caution.*
>>
>> Emergency physicians make the admitting diagnosis. That’s how they are
>> admitted but not necessarily what the doctors caring for them think.
>> Perhaps the admission H and P should be the start point. I’m not sure that
>> ER physicians or medicine should be graded on the admitting dx.
>>
>>
>>
>> *From:* Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
>> *Sent:* Thursday, December 06, 2018 6:07 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] DX measures
>>
>>
>>
>> This is a very interesting study (freely available) looking at the degree
>> of match between the admission diagnosis and what the authors call the exit
>> diagnosis.
>>
>>
>>
>> “Our results show that only the 21.67% of cases are identified correctly
>> on admission….”
>>
>>
>>
>> Could this be used as a measure for diagnosis quality in hospitals? I am
>> sure there will be concerns about the admitting diagnosis and clinicians
>> being rushed to put something down without enough time but the ratio
>> between the 2 diagnoses for an institution as a whole should be a useful
>> indicator as would the trend over time. If the measure drove institutions
>> to focus of getting the admitting diagnosis more accurate then that would
>> be good.
>>
>>
>>
>> This should also be practical to produce as would not involve the
>> clinicians in any additional work.
>>
>>
>>
>> In an earlier discussion, I asked if there were any measures that were
>> practical, where there were no concerns and that we could all support but
>> got replies. I really feel that if we are to get diagnosis the respect it
>> deserves from hospitals and health systems then we need a measure. We have
>> all been talking about this for a long time, but I do not sense we are any
>> further forward!
>>
>>
>>
>> Regards
>>
>>
>>
>> Jason Maude
>>
>> Founder and CEO Isabel Healthcare
>> Tel: +44 1428 644886
>> Tel: +1 703 879 1890
>> www.isabelhealthcare.com
>> <https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.isabelhealthcare.com-252F-26data-3D02-257C01-257Clisa.sanders-2540yale.edu-257Cfe876ee781744f85d84b08d65b88f4cd-257Cdd8cbebb21394df8b4114e3e87abeb5c-257C0-257C0-257C636797042785465062-26sdata-3D3gJPfS8jaQ6gcksJ6aiQFQ5i1hEa5QuWv0Q-252FnSoMC8c-253D-26reserved-3D0&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=KrqXFh0vaNpp4vZ8XEFV9Lih-dNw56ru69LkUUOirJg&s=w-Onp_UODys-R1hL9PainIePsDFSuTiCV2ByuxO1yr4&e=>
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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