Web-Based Tools Can Help Prevent Diagnostic Errors
The Veterans Administration and Kaiser Permanente are using new Web-based decision support tools in an effort to reduce errors and malpractice claims by targeting "the most common lapses in the diagnostic process," the Wall Street Journal reports.
According to studies, diagnostic errors occur in 10% to 30% of health care cases, and typically are caused by flaws in physicians' thinking, health care system glitches, or both. Physicians also can miss diagnoses when patients are seen by several providers who do not communicate, or when patients' complaints are not taken seriously, the Journal reports.
Kaiser and the VA are piloting a Web-based decision support program that provides physicians with an array of possible diagnoses they might not have considered. The program, called Isabel, is named after Isabel Maude, the daughter of co-developer Jason Maude, who was the victim of a diagnostic error when she was 3 years old. After physicians enter symptoms into a computer, the Isabel system -- which already is used by a growing number of hospitals, physician offices and medical-information companies -- provides up to 30 possible diagnoses.
The Isabel system costs hospitals $180 per bed annually, or about $54,000 annually for an average 300-bed hospital. It costs about $500 annually for individual physicians and group practices, the Journal reports.
Some physicians at Kaiser have complained that the system takes extra time and offers too many irrelevant diagnoses. However, a study of Isabel by Mark Graber -- the chief of medical service at the VA Medical Center in Northport, N.Y. -- found that the system offered the correct diagnosis in 98% of the cases. Physicians who use the system throughout the country have noted that it also helps in the training of medical students, the Journal reports.
Kaiser as part of its new electronic health record system also is testing a diagnostic tool for its emergency department. The Web-based system, called the Emergency Medicine Risk Initiative, prompts physicians and nurses to ask a series of questions, order certain tests and document their actions on patients' charts (Landro, Wall Street Journal, 11/29).