AN INNOVATIVE APPROACH TO ADDRESSING DIAGNOSTIC ERRORS AND SHARED DECISION MAKING

Statement of problem: A vital element to diagnosis is a robust patient history and his/her story, yet the patient is not adequately equipped with the understanding or tools to provide information that could become valuable liquid data to share with clinicians. Furthermore, the values and expectations of patients are rarely collected or recognized as important. Additionally, addressing the dual processes of individual and systemic cognitive errors is difficult if the ‘art’ of medicine is not incorporated into the science of medicine. Most importantly, if clinical decsion support (CDS) is not seamlessly integrated into normal workflow at the point of care to dynamically generate support and feedback it will be rejected.

Description of the intervention or program: Construct IT tool with patient engagement, dynamic history taking, linked to evidence-based medicine/practice with dynamic feedback mechanisms to support cognitive and shared decision making. Comprehensive evidence-based medicince (EBM) includes external evidence, clinical expertise and patient values and expectations. The IT solution in development is based on the Contextual Care Model below. The efficacy and effectiveness are replicable and the implementation and measurement provide sustainability. The core of the model is the patient, holistic and always centric. The implementation revolves around a collaborative, open, transparent database of structured, parsed and indexed EBM that matches patient-collected data with evidence-based disease sets to provide personalized predictive diagnosis.  

Findings to date: Physicians embraced the overall concept when shown how it could save them time, validate their own choice and improve their relationship with the patient. They were concerned about liability if they did not select the ‘predictive’ diagnosis but understood that they could document their reasoning. They liked the open, transparent, collaborative evidence that supported the choices integrated into the system. The most desired feature was the dynamically generated ‘next question’ to ask – this was the definitive cognitive support that was at their fingertips.

Lessons learned: Most physicians remain immune to diagnostic errors and interference with their workflow. They must see value and feel secure that it is helping the patient and their relationship with the patient. Those physicians that embrace accountable care are eager to test the solution. Specialists have little interest; primary care physicians, pediatricians, NPs and PAs are most eager to participate in studies.