Improving Diagnostic Safety

"Many senior researchers used to caution me saying, 'Are you sure you want to study this? It seems too hard, and we're not really sure if this is an important area.' And my answer was always the same, 'Well, one day it will be.'"

Hardeep Singh, M.D., M.P.H., has dedicated his research career to understanding diagnostic errors and improving safety in health care.  He is currently Chief of the Health Policy, Quality & Informatics Program at the Center for Innovations in Quality, Effectiveness and Safety based at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, Texas.

Dr. Singh’s passion for improving the safety of diagnosis is what led him to transition from a full-time primary care physician into a research investigator in 2005. Many experts he sought advice from at the time suggested it might be too challenging a field of study. "Many senior researchers used to caution me saying, 'Are you sure you want to study this? It seems too hard, and we're not really sure if this is an important area,'" he recalls. "And my answer was always the same, 'Well, one day it will be.'"

That day has come. Dr. Singh is among a distinguished group of researchers who are speaking at the September 28, 2016, AHRQ Research Summit: Improving Diagnosis in Health Care. He recently published a paper calling for the World Health Organization to consider eight priority areas for future research and development to improve diagnostic error prevention worldwide. His AHRQ- and VA-funded research was cited frequently in the recent Improving Diagnosis in Health Care report from the Institute of Medicine, and helped the committee make estimates on the frequency and significance of diagnostic error. He has worked with the World Health Organization on their recent Global Patient Safety Action Plan 2021-2030 which includes diagnostic safety as a priority area.

Through several AHRQ-funded research projects, Dr. Singh has focused on understanding the behavioral, technological, and organizational factors surrounding the use of electronic health records (EHRs). Some of his earliest research used health information technology to identify patients who might be at risk of having delayed diagnoses for prostate, lung, or colon cancer. Using EHR data, Dr. Singh and his multidisciplinary research team created computerized algorithms to enable identification of such patients. They also developed new EHR-based decision-support software to enable more timely followup of patients with abnormal test results related to cancer diagnosis.

Dr. Singh’s work has had a broad impact on the policy and practice in the U.S. Department of Veterans Affairs (VA), specifically on initiatives to improve the communication of test results. "Working in close partnership with clinical operations leaders, we helped develop and disseminate several guidance documents for the field," says Dr. Singh. "Our research has thus far informed three toolkits to help people on the front lines manage test results-related safety issues." In addition, he co-developed the national VA policy on communication of test results to patients and providers. This policy is in place at all VA facilities and collectively impacts care for millions of patients.

More recently, Dr. Singh has been leading an AHRQ-funded study that will test electronic trigger algorithms to detect patterns of care that suggest missed or delayed diagnoses from EHR data, harvesting safety signals from millions of patient records. This work uses the Safer Dx Trigger Tools Framework to detect, measure, and learn from diagnostic errors in diverse emergency department (ED) settings, including the VA and Geisinger health system.

Dr. Singh is also part of an AHRQ-funded Patient Safety Learning Laboratory project that is getting input from a broad array of stakeholders to better understand and reduce errors that occur in EDs and acute-care settings. The project, being led by the University of Michigan, Ann Arbor, brings together clinicians, patients, engineers, information scientists, and human factors designers who provide input into the diagnostic decision-making process and how decisions are implemented. Using design-centered principles, researchers are understanding factors that contribute to diagnostic errors and identifying interventions to reduce them.

In addition to his research on diagnostic errors, Dr. Singh has worked for many years to bring diagnostic error into the limelight through conferences that bring together experts in the field. He helped organize the AHRQ-supported Diagnostic Error in Medicine conference series, where researchers, practitioners, patients and experts discuss ways to advance the field of diagnostic error prevention. Some of his recent work involves developing learning health systems that can measure and improve diagnostic safety. His team authored an AHRQ Issue Brief on this topic and are now working with AHRQ to develop additional resources to enable health care organizations to work on diagnostic safety.

"Ultimately," says Dr. Singh, "it's all about making a difference in patient outcomes and changing the system where we clinicians practice so we can give the best possible care." His research on diagnostic error has received much national recognition. In 2012, he received the AcademyHealth Alice S. Hersh New Investigator Award for high impact research, and in 2014, he received the prestigious Presidential Early Career Award for Scientists and Engineers (PECASE) from President Obama for his pioneering work in the field. His research team was awarded the VA Health System Impact Award in 2016.

In 2022, Dr. Singh received the John M. Eisenberg Patient Safety and Quality Award from the National Quality Forum and The Joint Commission.

Principal Investigator: Hardeep Singh, M.D., M.P.H., Professor of Medicine – Health Services Research
Institution: Houston VA & Baylor College of Medicine, Houston, Texas
Grantee Since: 2008
Type of Grant: Various

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