A new study published in the BMJ Quality & Safety Journal by a group of researchers at the Johns Hopkins University School of Medicine found diagnostic errors to be the most common and costly medical mistakes.
The researchers evaluated payment data related to medical malpractice from the National Practitioner Data Bank, a comprehensive electronic collection of all malpractice settlement payments made by U.S practitioners since 1986. They found that diagnostic errors constituted 28.6% of 350,706 paid malpractice claims outranking other mistakes including treatment (27.2%), surgery (24.2%), obstetrics (6.5%), medication, (5.3%) and anesthesia (3%). Not only that, they were more likely to risk the lives of patients (40.9%) compared to other medical errors. Missed diagnoses were found to be the most common type of error compared to wrong and delayed diagnoses. Also, more diagnostic error claims were found in outpatient care than inpatient care (68.8 percent vs. 31.2 percent); and more lethal diagnostic errors were in inpatient care than outpatient (48.4 percent vs. 36.9 percent).
According to the research findings, misdiagnoses resulted in permanent disabilities to around 80,000 to 160,000 patients each year. Dr. David Newman-Toker (associate professor of neurology at the Johns Hopkins University School), one of the researchers says that most medical misdiagnoses are preventable. It is challenging too at the same time. In his opinion, this is mainly because of inadequate scientific knowledge and lack of technology (for instance, there is no technology to diagnose breast cancer as early as when the first cancer cell appears). He further points out that ordering every possible test for every possible occasion may provide you with accurate diagnosis, but it would simultaneously increase the healthcare costs. Here are Newman-Toker’s recommendations to reduce diagnostic errors.
- Encourage resource alignment when it is required to order costlier tests. For example, if you are trying to diagnose a stroke in patients, you need an MRI instead of a CT. MRIs are expensive but you don’t need to get them on 40% of the patients. Get them on 5% to 10% of the patients and you would be investing the resources more appropriately.
- Hospitals will have to be convinced to make their rate of medical diagnostic errors public, for which legislation or financial incentives from federal government or other regulatory bodies may be needed.
- Apart from treatments, more research should be funded for providing better diagnostic tests.
As per Dr. Hardeep Singh, a patient safety researcher at the Houston Veterans Affairs Health Services Research Center of Excellence and assistant professor of medicine at Baylor College of Medicine in Houston, diagnostic errors that occur outside of malpractice claims are equally important and it is required to conduct a research on them too. He is currently working on refining Electronic Health Records (EHR) to trace anomalous findings on test results. A recent report published in healthland.time.com talks about a survey carried out by the Michael E. DeBakey Veterans Affairs Medical Center in Houston, which revealed one third of primary care practitioners surveyed (around 2,590) reported missing alerts from EHR system designed to alert on abnormal test results. The efficiency of EHR system can be improved by accessing the required information with easier methods and training personnel on how to use the system.
The ICD-10 transition is expected to improve the accuracy of diagnoses as the new codes will provide a greater detail of health conditions and thereby more specificity in medical coding. The number of codes will increase to 90,000 from 17,000 to cover new diseases and procedures. The ICD-9 codes represent the closest health condition to be treated, not the very exact cause. As a result, physicians may need to look for more details which will eventually delay the treatment. On the other hand, ICD-10 codes can clearly express the severity of a condition (for e.g. pressure ulcers) by a single code. This will minimize diagnostic errors and confusion and ensure correct and timely treatment.
Let us consider the ICD-9 code 250.50 (Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled). Here the condition is unspecified. At the same time, there are four ICD-10 codes (given below) to specify this condition which gives a clearer insight.
- E11.311: Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
- E11.319: Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
- E11.36: Type 2 diabetes mellitus with diabetic cataract
- E11.39: Type 2 diabetes mellitus with other diabetic ophthalmic complication
The combination codes in ICD-10 which signify two diagnoses or a diagnosis with an associated secondary process/complication with a single code can be used to express multiple elements of a diagnosis. This improves coding efficiency as providers need not check several codes to diagnose a disease. ICD-10 is beneficial to healthcare providers in that they are ensured accurate payment thanks to more accurate medical coding and clean claims. Busy physicians can seek the help of a medical coding specialist to help with medical billing and coding.
It is a matter of concern that diagnostic errors are among the leading reasons for medical malpractice and its costly outcomes. With more awareness of this hazardous trend, providers can take effective measures to curtail the same and ensure patient safety. Wrong diagnoses also lead to erratic medical coding, which in turn not only compromises patient safety and care, but also has a negative impact on reimbursement and practice revenue.
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