Diagnostic errors continue to plague the healthcare system, but some progress is happening thanks to technology that can reduce the chance of an error reaching the patient and causing harm. Optimal results may require a more deliberate training program for those using the technology.
There remains some degree of art involved in medicine, with providers using their training and experience to interpret data, says Adam Saltman, MD, PhD, chief medical officer at Eko, a digital heart health company in Athens, OH. That means there always will be some risk of diagnostic errors. Still, technology is increasingly providing backups and assistance in making those judgment calls.
On the other hand, clinicians must be wary of turning over too much of their diagnostic skills to software and machinery.
“Sometimes, errors are due to physicians relying on diagnostic outputs too much, not really looking at them and saying, ‘wait a minute, this doesn’t make sense, I need to interpret this correctly,’” Saltman observes. “We’ve had more diagnostic technology than we’ve ever had before. Years ago, people were depending much more [on] physical exams and the physician’s skill and experience. We don’t want to go back to those times necessarily, but we don’t want to give up that valuable input.”
Saltman says that in his experience as a cardiothoracic surgeon, he saw people take diagnostics as “almost an absolute, like they felt the output of a diagnostic test was 100%, that it was 100% sensitive and specific, that it always gave a right or wrong answer.”
Saltman considers that is an educational problem. Clinicians should understand there is no diagnostic test that is 100% accurate. The key is understanding how to best work with diagnostic technology to incorporate it into the diagnostic process.
Saltman expects the future of reducing diagnostic errors to involve more and better technology, but also a better understanding of what the diagnostic outputs of particular software or machinery really mean.
Leapfrog Endorses Tech Solutions
The Leapfrog Group reported computerized physician order entry (CPOE) systems can be “remarkably effective” in reducing serious medication errors.1 Hospitals that have fully implemented CPOE “outperform hospitals that have not fully implemented CPOE on multiple measures of medication error,” the group reported.
CPOE reduced error rates by 55%, and rates of serious medication errors fell by 88% in a study from Boston’s Brigham and Women’s Hospital. The CPOE system’s structured orders and medication checks accounted for the safety improvement.
Leapfrog also noted length of stay at a facility in Indianapolis fell by 0.9 days, and hospital charges decreased by 13% after implementation of CPOE.
In another report, Leapfrog noted bar code medication administration systems were associated with reducing medication administration errors by up to 93%.2
Pandemic Plays a Role
The COVID-19 pandemic may result in an increase in diagnostic errors soon, just because people cannot seek routine and elective healthcare, according to David Richman, JD, partner with Rivkin Radler in Uniondale, NY.
“You probably will begin to see filings in connection with failure to diagnose in the midst of the pandemic, either because resources were limited by COVID-19 or physicians were so inundated with patients with the virus or at risk of the virus that other conditions may have been missed,” Richman explains. “There’s been an uptick in mortality associated with cancer because people weren’t going in for treatment or screenings. There has been an uptick in people dying of cancer in the midst of the pandemic.”3-5
Regardless of the pandemic’s effect, diagnostic errors continue to be a significant threat to patient safety and a medical malpractice risk. “Diagnostic errors have had a great impact on the cost of patient care because the cost of lawsuits has caused physicians and hospitals to practice defensive medicine, which has given rise to overtreatment, overdiagnosis, and overtesting,” Richman says.6 “That carries with it tremendous costs. Even with advanced technology, you may have physicians rendering diagnoses with more confidence because they think the technology backs them up, but you’re always going to have misses.”
Digitizing Can Reduce Errors
There is a distinction between medical errors and technology errors, according to Pouria Sanae, CEO of ixlayer, a company in San Francisco that provides technology-based solutions in diagnostic testing.
“Our goal is to minimize these errors by digitizing the process. Software solutions that can operate without manual input on all sides — the patient, the physician, and the lab — are the first line of defense to help fix problems that have plagued the health system for decades,” Sanae says. “Our nation’s doctors and hospitals rely heavily on faxes, even handwritten slips, to treat their patients.”
Digital tools can help minimize the human error. As health IT becomes a more critical part of healthcare organizations, these digital advancements and solutions can help minimize errors and provide more accuracy when it comes to testing, one of the core tenets of diagnostics.
Lack of understanding in functionality and usability of diagnostic products or systems can increase the chance of diagnostic errors or hinder the technology’s ability to improve patient care, according to Tanya Specht, RDMS, RDCS, RMSKS, clinical marketing manager with Exo, a health information and devices company in Redwood City, CA.
“A hospital may have a great diagnostic imaging system that produces the best images in the world, but that means nothing if its physicians do not know how to use it,” she says. “Physicians often lack complete understanding of existing medical devices available to them for diagnostics.”
Training Is Key
Some may receive training when a product or system is installed, and they will be well-versed in its use, according to Jonathan Bowman, RDMS, RDCS, RVT, ultrasound clinical sales manager with Exo. But there are some who cannot make the training session or others who join an organization without ever receiving training.
“Their inability to understand how to use the product/system correctly could lead to physicians putting in wrong information or leaving pertinent details out,” Bowman says. “Additionally, some physicians may need a refresher course on how to take quality medical images, no matter their seniority level.”
Specht and Bowman offer this advice for better using technology to reduce diagnostic errors:
- Implement continual training on all products and systems available within each department.
For example, when a facility purchases an ultrasound machine, it may or may not come with a day of training. But depending on the complexity of the system and the rate at which that hospital brings on new employees, it is likely additional days of training will be needed.
- Train users how to produce good diagnostic images.
Work with the medical imaging provider to create exams that clinicians can complete as part of the continual training program. Image quality could be evaluated by the provider or graded by senior-level clinicians to ensure they are recognizing pathology.
Evaluation could include grading images before and after completing the continual training program to see if individuals improved and by how much.
- Use simple medical devices and systems.
Technology should be intuitive enough that anyone can pick up and start learning through hands-on use or by simple tutorial, rather than through days of training — similar to operating a smartphone out of the box. The industry should move away from diagnostic tools that are loaded with keyboards, sliders, and knobs that increase the learning curve.
- Conduct quality reviews on images taken.
Look for programs and software that can be integrated within the current diagnostic system to grade the quality of images taken. This should be used as a tool to create an environment within the hospital of continual learning.
For example, an educational emergency department with an ultrasound program could use software or program to review all the ultrasound images to ensure they meet the level of quality expected.
- Streamline scanning, documentation, and billing into one program.
It is much harder for users to drop the ball when they do not have to switch between programs and enter multiple reports. Streamlining this process will help reduce clerical errors.
- Leapfrog Group. Leapfrog hospital survey. Factsheet: Computerized physician order entry. Last revision April 1, 2020.
- Castlight, The Leapfrog Group. Bar code medication administration. 2018.
- Sharpless NE. COVID-19 and cancer. Science 2020;368:1290.
- Chan JW, Lee VHF. Will the COVID pandemic lead to uncounted cancer deaths in the future? Int J Radiat Oncol Biol Phys 2020;108:351-352.
- Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. Lancet Oncol 2020;21:1023-1034.
- Kusterbeck S. Partly driven by defensive medicine, ED imaging orders rise dramatically. ED Legal Letter. December 2020.
- Jonathan Bowman, RDMS, RDCS, RVT, Ultrasound Clinical Sales Manager, Exo, Redwood City, CA. Email: email@example.com.
- David Richman, JD, Partner, Rivkin Radler, Uniondale, NY. Phone: (516) 357-3120. Email: firstname.lastname@example.org.
- Adam Saltman, MD, PhD, Chief Medical Officer, Eko, Athens, OH. Phone: (844) 356-3384.
- Pouria Sanae, CEO, ixlayer, San Francisco. Email: email@example.com.
- Tanya Specht, RDMS, RDCS, RMSKS, Clinical Marketing Manager, Exo, Redwood City, CA. Email: firstname.lastname@example.org.