Without a significant re-envisioning of the diagnostic process and a widespread commitment to change from a variety of stakeholders, diagnostic errors will likely worsen as the delivery of healthcare and the diagnostic process continue to increase in complexity, concludes a new report from the Institute of Medicine (IOM) released September 22, 2015, during a live webcast. The latest in IOM's quality chasm series, Improving Diagnosis in Health Care calls for more effective teamwork among healthcare professionals, patients, and families; enhanced training for healthcare professionals; more emphasis on identifying and learning from diagnostic errors and near misses in clinical practice; a payment and care delivery environment that supports the diagnostic process; and a dedicated focus on new research. Although the data on diagnostic errors is sparse, the IOM committee behind the report assessed the available evidence and determined that these errors stem from a variety of causes, including inadequate collaboration and communication among clinicians, patients, and families; a healthcare work system that fails to support the diagnostic process; and a culture that discourages the transparency and disclosure of diagnostic errors, which further thwarts prevention efforts. The report emphasizes that collecting this information, learning from these experiences, and implementing changes are critical for achieving progress and calls on healthcare organizations to promote a non-punitive culture that values open discussions and feedback on diagnostic performance. The report also calls for reforms to the medical liability system to support transparency and disclosure, as well as reforms to models of payment and care delivery to improve collaboration and highlight important tasks in the diagnostic process. IOM suggests that the Centers for Medicare and Medicaid Services and other payers could create codes and provide reimbursement for evaluation and management activities, such as the time spent by pathologists and radiologists in advising treating physicians on testing for specific patients. Furthermore, the report stresses that payers should reduce distortions in the overall structuring of fee schedules that place greater emphasis on procedure-oriented care than on cognitive-oriented care. IOM believes that these distortions may be diverting physicians' attention from important tasks in diagnosis, such as preforming a thorough clinical history, interview, and physical exam, because these tasks are not valued as highly by payers.

HRC Recommends: Risk managers should investigate ways to incorporate reporting of diagnostic errors into the organization's event reporting system and promote an environment that supports reporting. Other methods for identifying diagnostic errors include patient reporting of diagnostic errors, retrospective chart review, use of unannounced standardized patients for direct observation of clinicians' diagnostic skills, and use of administrative data (e.g., billing for tests) to identify possible diagnostic errors. None of these approaches can succeed without an organizational commitment to measure, monitor, and reduce diagnostic errors.