Last Tuesday’s report from the Institute of Medicine sent chills down America’s spine as the newest diagnostic data revealed that the vast majority of U.S. patients will get a wrong or late diagnosis in their lifetimes, often with devastating effects.
The report went on to disclose that these diagnostic errors caused about 10 percent of all patient deaths as well as about 17 percent of “adverse events,” or harms that occur to patients during a hospital stay.
Initially one would think that we should put the blame on the radiologists who are supposed to be the “diagnostic experts.” However, we as a healthcare industry have failed to provide these “experts” with the types of studies that they are specialized in interpreting and — as a result — are increasing the probability of a diagnostic error occurring.
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In 2015, it’s impossible for one radiologist to be an expert in all parts of the body, particularly with all the available imaging tools (MRI, CT, etc). The field of radiology has become too complex for any single radiologist, with more than 90 percent of all finishing radiology residents electing to continue training (i.e. entering a fellowship in subspecialty areas such as neuroradiology, musculoskeletal radiology, nuclear medicine, or women’s imaging).
Because of this, we’ve now unfortunately hit a point where the term “general radiologist” can mean a diagnostic inaccuracy if the radiologist is reading a study in a subspecialty area. But could we be doing better to match these general radiologists and subspecialty radiologists with the right studies in an effort to help reduce these dangerous diagnostic errors in medicine?
Take a look at mammography for example, which is one of the most common and routine diagnostic images that a radiologist interprets. While there are a number of radiologists who are subspecialists in reading mammograms, only 40 percent of mammograms are actually being read by a subspecialist in the field. To add to the problem, only 18 percent of subspecialty trained mammogram interpreters are actually interpreting in their specialty at any given time. How are we letting this be the case?
One of the primary calls to action pointed out in the Institute of Medicine report was to allow for better use of technology. We all know that healthcare is slow to adopt new technologies (case in point — the persistent lack of electronic health record adoption by leading healthcare institutions). However, if we want to make an impact on reducing the number of patient diagnostic inaccuracies that continue to occur, we need to make adopting the right technologies a priority.
Automation Didn’t Dehumanize Care. Bad Systems Did.
We have the opportunity to design systems that give people greater capacity for the work where human presence matters most: listening, understanding, reassuring, deciding, and caring.
Imagine a network of general and subspecialty radiologists that transcends geographic and organizational boundaries.
Imagine regional radiology practices with limited onsite subspecialists being able to access and utilize the expertise of their entire enterprise or leading imaging institutions.
Imagine a system that intelligently routes patient information, and images to the radiologist subspecialist best equipped to interpret them.
These are the kind of capabilities that will have a monumental impact on the radiologist’s care delivery model and will help to decrease the number of diagnostic errors that are occurring.
The best part — we already have all of the tools in place to make this forward-thinking a reality. Unlike other medical specialties, the entire radiology workflow is already digital, meaning that it can be measured, analyzed and optimized in real-time, and that it can be delivered to any radiologist regardless of their location.
Digital technology has the ability to transform the radiology delivery model by ensuring that the best radiologists for each specific study are being utilized. Leading providers with deep expertise can then optimize their existing practice and can assist in reengineering the care delivery model nationally, helping to improve patient diagnoses no matter where the subspecialty expertise exists.
The Institute of Medicine’s report could not have been more accurate in stating that improving diagnoses in healthcare will require significant re-envisioning of the diagnostic workflow process with a widespread commitment to change. Asking an entire industry to rethink the way that we deliver care is a big request, but allowing for this type of digital technology capability is a necessity if we want to improve patient care delivery.
Technology has been transforming industries since the industrial revolution, from farming, to textiles, manufacturing, transportation, and media. And, it’s now happening faster – and more fundamentally – than ever before. If we want our industry to start reducing diagnostic errors in medicine, the time is now to make the change and use digital technology to our advantage.
Dr. Frank Seidelmann is Chief Medical Officer at Candescent Health and is a lifelong radiologist with more than thirty years’ experience in radiology with subspecialty expertise in MRI and neuroradiology. Prior to his CMO role at Candescent Health, Dr. Seidelmann co-founded Radisphere, a national radiology group that employs over 120 radiologists and provides 1.3 million annual interpretations at over 60 facilities in 23 states. Before venturing into subspecialty teleradiology, Dr. Seidelmann co-founded a highly successful hospital and outpatient imaging center, which was acquired by Med Partners and later became Team Health. He also has owned several diagnostic imaging centers and co-founded RIS Logic, a leading radiology software company that supported diagnostic imaging centers. Additionally, he has held staff positions at the Cleveland Clinic Foundation and Case Western Reserve University.
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