How a patient-centered universal viewer can help ameliorate the problems of medical misdiagnosis and hospital readmissions
We often discuss issues in healthcare as if we are on the outside looking in trying to find a way to fix them, when in reality, each one of us is right in the middle of the problems. It is widely believed that each one of us has a 5% chance of being misdiagnosed – and, a significant percentage of those misdiagnoses will result in injury, prolonged illness, or death. In addition, 10-15% of us will be readmitted within 30 to 60 days after leaving the hospital for inpatient treatment.
When researching medical misdiagnosis and hospital readmissions, one can see that there are many proposed reasons and solutions. After I read a plethora of articles on both of these topics, I came away with the feeling that there are so many possible causes and proposed solutions that we will very likely get lost in the fray and end up with the exact same bad statistics 10 years from now. No one seems to agree on what to do to resolve these two problems.
One of the noted promising solutions for both the misdiagnosis and readmission problems is the implementation of electronic medical records (EMRs). Some agree that EMRs help in resolving these problems, but nobody really knows how many of the problems EMRs resolve, especially in regards to medical misdiagnosis. It stands to reason that an EMR would help with both of the problems, because placing more information in front of the doctor can only help, as long as it is in a way that the doctor can use and assimilate. Supposedly, this is what EMRs have accomplished. However, a few years after most hospitals have adopted EMRs, we still have a significant problem with medical misdiagnosis and hospital readmissions.
The Next Step
What will be the next step? Will we keep talking about it and trying to figure out how to count misdiagnosed cases, or will we actually take a next step? I would like to propose that the next step is the widely accepted use of a patient-centric universal viewer. I am prepared to show how this will significantly reduce the negative impact of medical misdiagnosis and hospital readmissions.
In its 2015 interoperability roadmap the Office of the National Coordinator for Health Information Technology (ONC) stated that “healthcare is to be delivered in a ‘person-centered manner’ which requires a high degree of information sharing and interoperability creating an interoperable health IT ecosystem.” A patient-centric universal viewer does just that; it aggregates all imaging data associated with a patient and brings it together in one place inside the EMR and helps to make a complete record centered around the patient.
Just in case you are not aware, there is a considerable amount of imaging data not included in the EMR. Pictures are taken in ED, scopes in OR, photos in wound care, videos in endoscopy and photos of slides from pathology. Most of this either does not get into the EMR or it gets into the EMR through a very manual process. As I have been told by directors of ED and OR, people are not always sure where to find these pictures once they do get manually scanned into the EMR. As one manager told me, “We know where they are, but nobody looks at them because first you have to go to a whole other module in the EMR, and then six clicks later you can finally view the image.”
I propose that a patient-centered universal viewer would help ameliorate the problems of medical misdiagnosis and hospital readmissions in four different ways.
1. First is that the universal viewer provides a platform for the physician to sit in front of a patient with a tablet and go through the entire storyboard of the health condition in question. The physicians have at their fingertips the radiology images, pictures from surgery, photos of the wound or tumor or original symptom, pathology, lab reports, and educational material. When the physician has easy access to all of this imaging material in one place, he or she is more likely to sit down with the patient and review the case with them, showing what happened and what needs to be done—a picture is worth a thousand words.
This activity has two results. First, the patient is more likely to follow the prescribed treatment regimen, thus reducing possibility of readmission. Second, this process opens up more and better communication between the physician and the patient. Most studies have confirmed that one of the main causes of medical misdiagnosis is poor communication between the doctor and the patient. If the patient has an opportunity to review his or her case thoroughly with the physician, it is more likely that important information from the patient that was previously missed will become part of the diagnosis.
2. The second way that a patient-centric universal viewer helps the process is that it allows better collaboration between physicians. With the universal viewer, the radiologist can also see the pathology slides, the pictures from surgery, the EKG, photos of the wound, and all pictures and images associated with the problem. The other departmental physicians get to see what they may normally see along with images from the other departments that they wouldn’t normally see. No one doubts that increased collaboration between healthcare professionals will help to decrease medical misdiagnosis. The patient-centric universal viewer helps facilitate this collaboration.
3. The third way that the universal viewer helps is that it gives the physician more information with which to make a diagnosis. Who doesn’t want a complete patient record? Then why was imaging left out of the EMRs and why is imaging outside of radiology often left out of the record? The universal viewer is attached to a vendor neutral archive which gathers the photos and images from all over the hospital in an automated, secure manner and makes them accessible in the EMR through a patient-centric universal viewer. This is the best way to get a complete patient record from the imaging side and with the universal viewer integrated into the EMR, a lot of good information is readily available to the physician. As it says on the HealthIT.gov website on the EHR benefits page, “When healthcare providers have access to complete and accurate information, patients receive better medical care.”
4. Finally, a universal viewer makes an easy way to provide the imaging data to the patient through a patient portal. It doesn’t matter how good of a patient portal a hospital has–if the images are not in a patient-centric viewer, it is hard to gather them all up and present them in the portal in meaningful way.
Because imaging companies have learned how to view all media, not just DICOM, they have developed object-based storage and can index and track all of the imaging data. Because they have developed ways to securely get the images from the departments to the VNA, taking the next step to a patient-centric universal viewer in the EMR is very possible.
Some imaging companies still don’t get it and their universal viewer is not patient-centric or is just a modified radiology viewer. Others do not have story-boarding technology that allows the doctor to review the whole record with the patient. Still other companies don’t yet understand wound care and ophthalmology, but there is a selection of good products out there.
Shop wisely and you can take the next step toward reducing medical misdiagnosis and hospital readmissions in your facility. That step may end up not only helping your patients, but you and your family and myself and my family!