Wall Street Journal Examines Efforts by Kaiser Permanente, VA To Prevent Diagnostic Errors

The Wall Street Journal on Wednesday examined how Kaiser Permanente and the Department of Veterans Affairs "are leading new efforts to improve diagnostic accuracy." According to the Journal, "diagnostic errors are the Achilles' heel of medicine -- yet little has been done to prevent their deadly toll." Studies have found that diagnostic errors occur in 10% to 30% of cases and "generally stem from flaws in doctors' thinking, glitches in the health care system or some combination of both," the Journal reports. According to a 2002 study conducted by the Agency for Healthcare Research and Quality, diagnostic errors that might have changed patient outcomes are found in 5% to 10% of all autopsies. A study published last month in the Annals of Internal Medicine also found that of 300 closed medical malpractice claims, 59% involved diagnostic errors that injured patients.

Kaiser, VA Efforts
In response, Kaiser and VA have begun to use Internet-based "decision-support" programs, such as isabelhealthcare.com, that provide physicians with "an array of possible diagnoses they might not have considered" and prompt them to "perform appropriate tests on patients with certain symptoms," the Journal reports. Mark Graber, chief of medical service at VA Medical Center Northport in New York found that the Isabel system provided the correct diagnoses in 98% of cases. The Isabel system costs about $54,000 annually for a 300-bed hospital and about $500 annually for individual physicians and group practices. In addition to the Isabel system, Kaiser has begun "pilot-testing" the Emergency Medicine Risk Initiative, an Internet-based diagnostic tool for emergency department physicians. The tool prompts physicians and nurses to ask a series of questions, order certain tests and record their actions on a chart for patients who present with high-risk symptoms. Doug Bonacum, vice president of safety management at Kaiser, said, "There are so many things that can go wrong from trying to get patients in for an exam, to follow up after treatment that we need to take a more systemic approach." Stephen Borowitz, a specialist in pediatric gastroenterology at the University of Virginia Children's Hospital, said, "This is really a culture change for doctors. We have to face that we can't really know it all or carry all the medical knowledge in our heads" (Landro, Wall Street Journal, 11/29). Please note: The Kaiser Family Foundation is not associated with Kaiser Permanente or Kaiser Industries.