8 ways policy makers could reduce diagnosis errors

The Robert Wood Johnson Foundation is taking on the problem of diagnosis errors in healthcare and has issued eight recommendations for how these types of medical errors could be reduced through policy and healthcare system changes.

According to the Foundation’s new report, diagnosis errors are relatively common. Indeed, speak to any doctor and he or she will likely recall at least one patient where the diagnosis was wrong and as a result, the patient was harmed. However, diagnosis error is a very difficult safety concern to quantify. Even coming up with a ballpark estimate of how many diagnosis errors occur each year is difficult. The Robert Wood Johnson Foundation reports puts its best guess given the data available at one in 20 Americans being affected by a diagnosis error each year.

Many diagnosis errors are never discovered, but among those that are, some can be quite serious and even deadly. Therefore, the Robert Wood Johnson Foundation is calling for increased attention to diagnostic accuracy as a key component of healthcare quality and more research into the system factors that lead to diagnostic errors.

The Foundation notes that medicine is complicated and there is a category of diagnostic errors that would be considered no fault. However, it puts less than 10 percent of diagnosis errors into this category. The remaining majority of diagnostic errors are related to the clinician’s cognitive biases and failings in processing perceptions, as well as system and process factors like information being lost in care transitions (poor hand-offs) and failing to follow up on results from certain diagnostic tests. Interestingly, the report noted that while lack of knowledge on the part of the clinician is usually thought of as a prime cause of diagnostic errors, this is not so. Cognitive biases and failings in processing perceptions can happen to even the most knowledgeable doctors, and sometimes great knowledge about a field can actually increase biases and lead to the physician seeing patterns in patient data that in fact are not there.

The Robert Wood Johnson Foundation is of course focused on healthcare policy and therefore takes a health policy approach to reducing these types of preventable diagnostic errors. The eight changes the Foundation recommends in its report are:

1. Enhance research into the complicated causes of preventable diagnostic errors using the government’s National Institutes of Health, the Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI).
2. Require as an enhanced condition of participation in Medicare that hospitals and institutions demonstrate structural elements and performance measurement of certain processes related to diagnosis errors.
3. Use the AHRQ Patient Safety Organizations (PSOs) as a possible way mechanism for developing the epidemiology of diagnosis errors and for gathering useful feedback to clinicians and organizations trying to reduce diagnosis errors.
4. Involve patients in gathering feedback and outcome data related to diagnosis errors.
5. Reform medical malpractice rules so that physicians can examine errors, promptly compensate patients, and work to prevent future mistakes.
6. Leverage electronic health record tools for organizing and presenting information clearly, as well as new technologies to assist with clinical decision making, to help physicians and other healthcare providers make the right diagnosis. At the same time, reduce EHR documentation requirements that can clutter records with duplicated cut-and-paste sections of information entered primarily for billing purposes.
7. Improve payment systems to reward results rather than volume of activities, procedures and tests.
8. Adjust Medicare payments to teaching hospitals to reward those with graduate medical education programs that include a focus on diagnostic error prevention.