IOM report urges action on controlling diagnostic errors

Inaccurate or delayed diagnosis can have serious consequences for patients, yet efforts to reduce such diagnostic errors have been limited, according to a report from the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine.

The report, “Improving Diagnosis in Health Care,” claims most people will experience at least one diagnostic error in their lifetime.

While data are sparse, the report cites a wide variety of causes for diagnostic errors, including inadequate communication, limited feedback to clinicians about diagnostic accuracy and a culture that discourages transparency and is not designed to optimally support the diagnostic process.

“Diagnosis is a collective effort that often involves a team of health care professionals -- from primary care physicians, to nurses, to pathologists and radiologists,” John R. Ball, MD, chair of the committee that authored the report and executive vice president emeritus of the American College of Physicians, said in a statement. 

“The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error,” Ball added. “Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis made.”

The report committee outlined the following eight goals to reduce diagnostic error:

• Facilitate more effective teamwork in the diagnostic process among healthcare professionals, patients, and their families.
• Enhance healthcare professional education and training in the diagnostic process.
• Ensure that health IT supports patients and health care professionals in the diagnostic process.
• Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.
• Establish a work system and culture that supports the diagnostic process and improvements in diagnostic performance.
• Develop a reporting environment and medical liability system that facilitates improved diagnosis through learning from diagnostic errors and near misses.
• Design a payment and care delivery environment that supports the diagnostic process.
• Provide dedicated funding for research on the diagnostic process and diagnostic errors.

One example of a specific policy change recommended by the report is the provision of coverage, from CMS and other payers, for evaluation and management activities, including time spent by radiologists on advising treating physicians about tests for specific patients.

The report is part of IoM’s “Quality Chasm” series, and was sponsored by a number of government organizations and professional associations, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and American College of Radiology, among others.