IOM on diagnostic errors: 'Urgent change is warranted'

Most people will experience at least one diagnostic error in their lifetime, according to a new report from the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine.

Those errors include an inaccurate or delayed diagnosis which can have devastating consequences and affect one in 20, or about 12 million, patients annually. They also account for hundreds of thousands of adverse events and nearly 10 percent of all patient deaths.

Despite those figures, the IOM said providers aren't addressing such errors in favor of other safety concerns.

EHRs can act as barriers to correct diagnoses, according to the report. "Auto-fill" functions can result in erroneous information being entered; EHRs often lack interoperability; and the volume of inputs and alerts can overwhelm staff.

"Urgent change is warranted to address this challenge," the report says.

The report offers several suggestions for vendors and the Office of the National Coordinator for Health IT (ONC) including align with clinical workflows; demonstrate usability; facilitate the flow of information among patients and providers; incorporate human factors knowledge; integrate measurement capability; and provide clinical decision support.

IOM called for ONC to require health IT vendors by 2018 to comply with interoperability standards that facilitate the flow of patient information across care settings and patient access to EHRs include clinical notes and diagnostic test results.

Meanwhile, health IT vendors should be required to "notify users about potential adverse effects on the diagnostic process related to the use of their products"; submit their products for routine independent evaluation; and support the free exchange of information about real-time user experiences with health IT design and implementation that negatively affect the diagnostic process.

The committee that conducted the study and wrote the report found that although getting the right diagnosis is a key aspect of healthcare, efforts to improve diagnosis and reduce diagnostic errors have been quite limited, according to an announcement on the report. Improving diagnosis is a complex challenge, partly because making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different healthcare settings. To improve diagnosis and reduce errors, the committee called for more effective teamwork among healthcare professionals, patients and families; enhanced training for healthcare professionals; more emphasis on identifying and learning from diagnostic errors and near misses in clinical practice; a payment and care delivery environment that supports the diagnostic process; and a dedicated focus on new research.

Patients and their families are "critical partners in improving the diagnostic process," the report says, so the committee recommended that healthcare organizations and professionals provide patients with opportunities to learn about diagnosis, as well as improved access to EHRs. Healthcare organizations and professionals also should create environments in which patients and families are comfortable sharing feedback and concerns about possible diagnostic errors.

The committee also recommended that healthcare professional education and training emphasize clinical reasoning, teamwork, communication and diagnostic testing. It urged better alignment of health IT with the diagnostic process and said federal agencies should develop a coordinated research agenda on the diagnostic process and diagnostic errors by the end of 2016.

Access the complete report.