Commentary: Diagnosis Tracking and Health Reform

Abstract

Monitoring and feedback of diagnostic errors is essential for quality diagnosis and inimical to the direction in which the United States health delivery system is heading. Tracking diagnosis evolution lon gitudinally can provide rich clinical insights to im prove the timeliness and accuracy of diagnosis, yet we lack even primitive systems to accomplish this function. Ten examples are listed, illustrating key questions regarding misdiagnosis. A system for tracking admit ting diagnosis revision is presented as a primitive diagnosis tracking prototype. An automated system is required to generalize this system to a longitudinal outpatient setting. The perils in the implementation of diagnosis tracking include the potential for fear-inducing pu nitive application, tampering with appropriate diag nostic strategies due to failure to distinguish common from special cause variation, and the affixing of "price tags" to diagnoses. The latter is an especially worrisome side effect of market-driven health re form, and threatens the success of the project.