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March 01, 2006

Sometimes people die for lack of ICD

According to The New York Times, a study in The Journal of the American Medical Association found that doctors misdiagnose fatal illnesses about 20% of the time, and that this rate has been the same since 1930 (Leonhardt, "Why Doctors So Often Get it Wrong", NYT, 22 Feb 2006). The NYT argues that the problem is largely one of missing incentives:

Doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

This problem is a bit off-topic for us, since it doesn't directly concern the design of information or communication technologies. However, the NYT reports that a software program has been developed to help avoid the problem: a diagnostic expert system from Isabel Healthcare that takes as input a list of symptoms, and returns a list of possible diagnoses, to remind doctors of the range of possibilities in case they forget or don't recognize some. However, the NYT suggests, the software is not being adopted widely because it is expensive, and hospitals do not have the right incentives to get the diagnoses right.

Question for thought: how might we introduce incentives for using an expert system like this that might improve the efficiency and success rate of diagnosis? Perhaps insurance companies (which save on drug and treatment costs if incorrect diagnoses are avoided) might offer a credit to hospitals for reducing their mis-diagnosis rate below the average for the past three years?

(Thanks to George Furnas for pointing me to this article.)

Posted by jmm at March 1, 2006 12:52 AM


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