Initiative Spurs Dialog, Action on Misdiagnoses

The ACT for Better Diagnosis initiative that launched this week wants to heighten awareness about diagnostic errors, and give stakeholders strategies to reduce them.

A coalition of more than 40 healthcare and patient advocacy organizations this week launched a two-year initiative to improve medical diagnoses, which by some estimates kill as many as 80,000 people each year in the nation's hospitals.

ACT for Better Diagnosis, is led by the Society to Improve Diagnosis in Medicine. SIDM CEO and Co-founder Paul L. Epner spoke with HealthLeaders about the initiative. The following is a lightly edited transcript.

HLM: What are actionable steps that providers can take to reduce diagnostic errors?

Epner: It's a long list. Everything from closing the loop on test results, trying to make sure that test results are communicated to physicians, that they interpret them correctly and that they communicate that to the patient.

That's a very basic thing, but it is a very big issue; closing the loop on referral testing. Having physicians and other clinicians just think a little bit more about the alternatives that might be in involved with the patient's symptoms. There are really many steps, some of them quite simple, some of them more complex, but all very doable.

HLM: What is the status of the initiative?

Epner: It officially has been launched this week, but we've been working on it for months with our coalition partners. The whole movement to improve diagnostic safety and quality started a decade ago.

HLM: What do you hope to achieve?

Epner: One of the problems associated with diagnostic safety and quality is the lack of awareness and steps one can take to overcome obstacles in the system. We want to bring attention to that and make sure that people know that there are things they can do.

We have a coalition that numbers more than 40 organizations, and they work with us to identify those obstacles and to create a platform so that every organization can figure out strategies for working around those obstacles and improving diagnosis. Every organization in the coalition is taking action on their own within their own organizations to do something to work around those obstacles and improve diagnosis.

Each organization is working on the steps they can take, based on being aware of the obstacles that they have collectively assembled. There are many other things going on outside of this initiative that will also bring forth more information. There are already recommendations.

HLM: What is the most common reason for misdiagnosis?

Epner: I don't know that there's one reason. Diagnostic quality and safety issues are associated with both cognitive and systematic breakdowns. On the cognitive side, it's something we call premature closure. It's not ordering the right tests. It's not interpreting the results properly.

On the systematic side, it can be a variety of things having to do with timeliness issues; getting results back from imaging or testing. It could be just access; employers giving patients time off to go to the physician when they have symptoms that are unexplained and bothering them.

The system has plenty of issues and physicians and other care providers have the cognitive issues on top of that.

HLM: Is there a common denominator for diagnostic errors?

Epner: Each member of the coalition is representing different elements of the care delivery system, and there are steps that every one of them can take. There's a role for nurses, roles for physicians, roles for lab people and imaging. There are roles for payers and roles for patients and so that one common theme is that everyone can do something.

Even providing feedback—patients don't necessarily let their physicians know when things aren't getting better. They go to a different physician and the original physician is never aware that things didn't get better. Our systems are just not set up to be robust.

HLM: Who is funding this initiative?

Epner: There are two primary funders. There is a two-year grant from the Gordon and Betty Moore Foundation and the Mont Fund. Together they have given us $3.1 million.

HLM: What do you expect to have accomplished in two years?

Epner: We expect people to be much more aware. We expect conversations to be ongoing and on a more frequent basis, and for people to be taking action. Whether or not we can see a needle move in two years, I think that's going to be more difficult. But we will look for the indirect measures of engagement.

This problem is the No. 1 source of malpractice in the U.S., in terms of dollars paid out, in terms of claims, in terms of severity of claims. These are the kinds of things where over time we will see impact. Will we see in the next 18 months? Not necessarily.

HLM: How do you get buy in from clinicians?

Epner: No one wants to do a bad job. They all want answers. Clinicians are highly skilled, highly trained, and most often get it right. They know diagnostic errors are a problem. They know it's impactful and they know they can make a difference. We've had no problem engaging the more than 40 organizations. Not only will they lend their name, but they will take action.

It's not just the healthcare professionals. Patient organizations like the American Heart Association, the American Cancer Society, they've all gotten involved too. There are steps and engagement for both patients and healthcare professionals.

HLM: What metrics will you use to determine whether or not this initiative is successful?

Epner:  The metrics will be more around media mentions, publications, individual institutions engaging, the steps of the organizations who are members, and the growth in the number of organizations that participate. It will be relatively indirect but important as a precursor to more objective measures of actual reduced harm.

HLM: It sounds like one of the primary functions of this initiative is to get people thinking and talking about diagnostic errors?

Epner: Absolutely. It's thinking about it. It's talking about it. It's doing something about it.