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Diagnostic Errors in Medicine: What Do Doctors and Umpires Have in Common?
Knowledge deficits are rarely the cause of cognitive errors in medicine; these errors more commonly involve defective synthesis
of
the available data. More than 40 cognitive pitfalls have been described. In our studies, the three most common pitfalls were:
Context errors: The physician inappropriately limits consideration to only one set of diagnostic possibilities, in lieu of
others. For
example, gastrointestinal causes are not considered for a patient presenting with chest pain.
Availability errors: The physician chooses the most likely diagnosis over conditions that are more rare, or they choose conditions
they
are most familiar with. An example would be the patient with a dissecting aortic aneurysm whose chest pain is attributed to
a musculoskeletal
strain.
Premature closure: Once a plausible condition is identified, other possibilities are not fully considered; we just stop
thinking.
In Conversation with...Joseph Britto, MD CEO and Co-founder of Isabel Healthcare Inc.
After some early hope that it would be pretty easy to enhance physician diagnostic decision-making through information technology
in
the 1970s and 80s, these efforts appeared to hit a wall. What gave you the feeling that the time was right to approach this
again? Britto:
The essential innovation was natural language processing, which is basically the ability of software to "make sense" or
"read" documents.
Development of State Level Health Information Exchange Initiatives
this report addresses three specific aspects of the operation of state-level Regional Health Information Organizations (RHIOs):
Explore the potential roles of and interactions between state-level RHIOs and federal activities for healthcare and information
technology.
Identify, examine, and analyze health information exchange (HIE) projects that have achieved financial sustainability.
Explore the roles of public payers and their influence on state-level HIE activities
Using EHRs to extract data on adverse drug events
Electronic health records could be used to automatically capture data on any adverse reactions or side effects of new drugs
on the
market. If such a system were in place information that now takes years to gather could be collected in a matter of months.
Other experts
also see the potential of using EHRs for post-market drug safety surveillance...
Computerized Indicators of Potential Drug-related Emergency Department and Hospital Admissions
Thirty-nine indicators were coded and were used in an automated search of claims data. The incidence densities for indicator
positives were 1.96 per 1000 patient-years in the general population and 13.6 per 1000 patient-years among older persons.
Age, male sex,
number of medical conditions, and number of medications from different classes were associated with an increased rate of indicator
positives.
Indicators of potential drug-related morbidities can be fully automated and used to search through medical and pharmacy claims.
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Feb 15, 2007 : Vol.10 No.4
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