Find and Fill: Gaps in Care
So many gaps, so little time.... That would be a ready conclusion from the extensive body of literature on gaps in patient care, medical errors, and patient safety. A recently released in-depth report from the American Medical Association, Research in Ambulatory Patient Safety, chronicles gaps related to diagnostic, laboratory, clinical knowledge, communication, and administrative (potential) errors. The possible combinations among these five domains is extensive. The report highlights the measurement activities of the Agency for Healthcare Research and Quality, CMS’s Physician Quality Reporting Initiative, the National Committee for Quality Assurance, the National Quality Forum, Meaningful Use Clinical Quality Measures, and the Joint Commission for Accreditation of Healthcare Organizations’ Patient Safety Goals.
At the risk of oversimplification, it strikes me that two prescriptions for improvement would address the great majority of gaps. First, knowledge- or evidence-related gaps in diagnostic, laboratory, medication, and clinical integration could be substantially enhanced through clinical decision-support tools. The ease of use, the availability of a myriad of hardware options, and the choice of software and cloud-based configurations make this completely achievable. Physicians and other clinicians should not feel threatened by "Watson" but should embrace the power of artificial intelligence / peripheral brains to free up their neurons to take advantage of machines’ mastery of data retrieval and information integration.
Second, reinvigorating and revitalizing health care encounters through patient/ clinician interactions that are thoughtful, with focused but unpressured conversation, will go a long way to address the remaining gaps and errors. Leaders in medical education, policy makers, and payers must work to see that these skills are taught, acknowledged and rewarded.
Steven R. Peskin, MD, MBA, FACP, is medical director of Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey, and associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey — Robert Wood Johnson Medical School.