Next Steps to Improving Diagnostic Safety
It's never easy hearing a story about unnecessary harm endured by a patient who received wrong or unnecessary treatment—or something worse—because of a misdiagnosis. But the stories told last September at AHRQ's Research Summit on Diagnostic Safety were numerous, upsetting, and sometimes tragic.
I remember leaving the meeting convinced that AHRQ's role as a leader in patient safety could be leveraged even more to increase awareness and provide much needed support for clinicians, patients, and others as we tackle the immense problem of diagnostic errors. We recognize the need for a wide range of collaborators, and we're pursuing this necessity by working with several others such as the Society to Improve Diagnosis in Medicine and the Coalition to Improve Diagnosis to achieve an integrated and coordinated approach for improving diagnosis.
Indeed, an article in this month's edition of Diagnosis, authored by members of AHRQ's patient safety team, builds upon themes from the summit by outlining key challenges and areas for potential future research and improvement related to diagnostic errors. Among them are: more robust engagement of patients as an integral part of their health care team; a deeper understanding of diagnostic errors and how to most effectively measure them; successful use of health information technology (IT) to prevent diagnostic error; and structures that optimize how organizations operate and enable better diagnoses for patients.
By no means exhaustive, this list of goals nonetheless demonstrates that diagnostic safety research is an emerging enterprise and one that will need considerable attention in the future if meaningful gains are to be made. I'd like to flesh out each theme a bit more as a way to describe the challenging and, in AHRQ's view, exciting road ahead and the opportunities we see for improving diagnostic safety.
- If you can't measure it, you can't improve it. We want to get better at tracking and understanding diagnostic errors and make this information available where it matters most—in the hands of those on the frontlines of care. To do so, we must continue to focus on measure development and overcoming the obstacles to gathering the right types of data. We are working with partners to identify opportunities to more efficiently capture important information to clarify the factors that contribute to diagnostic errors and use this knowledge to prevent them. We have collaborated with the Office of the National Coordinator for Health IT in their work with the National Quality Forum (NQF) to use research conducted by AHRQ and others and address measurement gaps in diagnostic accuracy. NQF has published a draft measurement framework that is available for public comment through July 12, 2017.
- Make health IT work to improve the diagnostic process. From information gathering, to helping doctors with the decision process, to learning from errors, health IT can be a powerful tool for improving diagnosis. For example, AHRQ-supported research is currently underway to better understand how natural language processing can help collect relevant information from unstructured data within a patient's electronic health record and present the data in a more usable way for the care team.
- Engaged patients are part of the health care team. The popularity of patient portals and mobile health applications that collect patient-generated health data are getting patients more actively engaged in their care. These tools can also help clinicians gather information prior to diagnosis. AHRQ is supporting research on how best to collect and utilize patient-reported outcome data to improve the quality and safety of care, better integrating the patient perspective into clinical practice.
- More learning health care organizations are needed. Organizations that gather data on diagnostic errors, learn how to implement findings from that data, and change their approach to diagnostic challenges based on that research are a necessity. Furthermore, leadership is critical to help health care organizations prioritize targets and use tools that work. Our toolkit, Improving Your Office Testing Process, is an example of how a medical office staff can use proven methods to improve the handling of diagnostic tests.
With these themes in mind, AHRQ is looking for practical ways to push the field forward. In an editorial that accompanies the Diagnostics article, AHRQ Deputy Director Sharon Arnold, Ph.D., describes the Agency's efforts to adapt our proven patient safety tools to focus on diagnostic safety. In addition, we’re exploring clinical decision support and how to harness technology to bring information to clinicians at the right time, and assist with making the right diagnosis. We're interested in supporting research aimed at improving diagnosis in all settings of health care, and we are actively soliciting funding proposals for diagnostic safety research with a focus on two particularly important areas: the incidence and causes of diagnostic errors in ambulatory care; and improvement strategies and interventions.
Diagnostic safety is an issue that affects us all. In fact, studies show that most adults will experience at least one diagnostic error in their lifetime. Even if we are not the ones receiving the misdiagnosis, we may be the person providing assistance to a loved one struggling to get the right diagnosis. Getting the diagnosis right is critical. It establishes the basis for options and difficult decisions that patients will face and all of the steps that follow. Accurate diagnoses guide the course of treatments, and the dedicated activities of clinical teams as they work together to achieve the best outcomes that modern medicine can offer. As we continue to focus on this critical issue, I look forward to keeping you posted on our shared progress.
Dr. Brady is Director of AHRQ's Center for Quality Improvement and Patient Safety.
Page originally created June 2017