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A learning health system approach to improve diagnosis

Diagnostic errors – missed opportunities to make timely and accurate diagnoses – are hard to tackle because they are difficult to identify and measure. The 2015 National Academy of Medicine (NAM, formerly IOM) report entitled “Improving Diagnosis in Health Care” highlights the necessity and significance to improve the diagnostic process. Different studies indicate that 10-30% of all medical errors are related to errors in diagnosis. The NAM estimates that most Americans will experience a diagnostic error at least once in their lifetime. The Agency for Health Research and Quality (AHRQ) considers improving diagnosis as the next great frontier in the patient safety improvement movement. In May 2019, the AHRQ, named diagnostic errors as one of the three “critical challenges that are front and center in today’s ever-changing digital healthcare ecosystem”.

We have a professional and moral imperative to address this formidable challenge.

At Geisinger, the Committee to Improve Clinical Diagnosis (CICD) was established as a work group in 2014 to develop innovative approaches to identifying and addressing diagnostic errors. Today, the committee has representation from all major disciplines and includes many senior clinical directors, operational leaders and key stakeholders. It is currently chaired by Yatin Mehta, MD, Associate, Pulmonary and Critical Care Medicine. Dennis Torretti, MD, chairman emeritus of the Division of Medicine at Geisinger was the founding chair from 2015 until April 2021.  

As a result of the work of the committee, potential diagnostic opportunities are reviewed, shared with departments, and learning opportunities are identified. Constructive feedback is completed when appropriate and any system issues that may impact diagnostic safety are identified. Lessons learned are shared broadly in an open, transparent, and constructive fashion. 

Committee to Improve Clinical Diagnosis

Committee members

Amit Bansal, MD, MBA
Director, Department of Hospital Medicine, Central Region, Geisinger
Clinical Associate Professor of Medicine, Geisinger Commonwealth School of Medicine

Keith Boell, DO
Vice Chair for Clinical Affairs, Medicine Institute
Chief Quality Officer, Population Initiatives

Jay Bringman, MD
Vice Chair and Quality Director, Women’s Health Service Line, Geisinger

Alison Brodginski, DO
Associate Chief Medical Officer, GWV
System Director Public Health Preparedness

Greg Burke, MD
Chief Patient Experience Officer, Geisinger

Navneet Dang, MD
Chief Quality Officer (System/Inpatient)
Attending, Hospital Medicine

Ross Ellison, MD
Director of Geisinger Placement Services
Emergency Medicine Physician, Geisinger

Michael Fitzpatrick, MD
Co-Chair, Department of Emergency Medicine, Geisinger
Associate Chief Medical Officer, Geisinger Medical Center

Benjamin Hohmuth, MD, MPH
Chief Medical Informatics Officer, Geisinger
Attending, Hospital Medicine

Lauren Adrienne Johnson-Robbins, MD
Associate, Neonatology

Maria Kobylinski, MD
Chair, Community Medicine, Geisinger

Saritha Korukonda, MD, MS
Project Manager, Safer DX Learning Lab, Geisinger

Patricia Lamphear, RN, JD, CPHRM 
Director, Risk Management & Patient Safety

Lauren Love, CRNP
Chief Advanced Practitioner, Hospital Medicine, Western Region

Gerald Maloney, MD
Chief Medical Officer, Geisinger System Hospitals

Kyle Marshall, MD
Emergency Medicine Physician and Informatician, Geisinger
Associate Program Director, Clinical Informatics Fellowship

Yatin Mehta, MD (Chair)
Associate, Pulmonary and Critical Care Medicine

Prince Mohan, MD
Medical Director, Kidney Transplant Program

Eric Newman, MD
Director of Quality and Innovation, Geisinger Medicine Institute 
Associate, Department of Rheumatology, Geisinger

Anthony Noto, MD
Director, Acute Neurology, Geisinger

Rajiv Panikkar, MD
Chair, Geisinger Cancer Institute

Aalpen Patel, MD
Chair, Geisinger Radiology

Anthony Petrick, MD
Director, Division of Bariatric and Foregut Surgery, Geisinger
Chief Quality Officer (Surgery/ Inpatient)

David Rolston, MD
Chair, Department of Medicine Specialties
Director, Division of General Internal Medicine, Geisinger Medical Center

Scott Sauerwine, MD
Quality Director, Geisinger Radiology

Conrad Schuerch, MD
Chairman Emeritus, Geisinger Laboratory Medicine
Residency Program Director

Jonathan Swinden, MD
Attending Hospitalist, Geisinger
Core Faculty - Internal Medicine Residency

David Talabiska, MD
Associate, Gastroenterology, Geisinger

Dennis Torretti, MD
Chairman Emeritus, Department of Medicine, Geisinger

Divvy Upadhyay, MD, MPH
Researcher-In-Residence, Safer Dx Learning Lab, Geisinger
Scientist, Division of Quality, Safety and Patient Experience, Geisinger

Jennifer Vodzak, MD
Quality Director, Pediatrics
Pediatric Infectious Diseases Specialist, Geisinger

doctors looking at computer

“We have developed a Committee to Improve Clinical Diagnosis to target vulnerabilities in the diagnostic process and sustain a culture of diagnostic excellence.” 

Dr. Dennis Torretti, Founding Chair, Committee to Improve Clinical Diagnosis, Geisinger