Organizers and Facilitators: James Harrison, Angela Keniston, Katie Raffel, Nora Hutchinson, Kieran Patel, Rob Young

The SHARE-DX Framework

Diagnostic error remains a leading cause of preventable patient harm, yet much of diagnostic reasoning occurs invisibly. To address this challenge, the ADEPT team, in partnership with the HOMERuN Patient and Family Advisory Council, developed SHARE-DX, a framework designed to make diagnostic reasoning more transparent and invite patients and families into the diagnostic process.

SHARE-DX encourages clinicians to:

• Set the Stage
• Hypothesize Together
• Align with the Lived Experience
• Discuss Red Flags, Risk & Roadmap
• Educate & Engage

Rather than creating a new task, SHARE-DX aims to restructure conversations that already occur during admissions, rounds, and diagnostic reassessments so they function as a diagnostic safety check. During a recent HOMERuN collaborative call, members explored an important question: How can SHARE-DX be implemented in real-world hospital medicine?

What We Heard

Across breakout groups, participants expressed strong support for the core concept. Hospitalists felt SHARE-DX addresses an important gap by making diagnostic reasoning visible, strengthening trust, and creating opportunities for patients and families to contribute information that may improve diagnostic accuracy. Many noted that elements of SHARE-DX already occur informally in practice, but the framework provides a way to make those conversations more intentional. Several participants also highlighted its value as a teaching tool for residents, students, and early-career clinicians.

"It tells patients, 'You're part of this discussion. And I need you to be part of this discussion.'"

Challenges to Implementing SHARE-DX

While participants strongly supported the goals of SHARE-DX, discussions focused heavily on the practical challenges of implementation. Across breakout groups, the dominant concern was feasibility. Key challenges identified included:

• Time and workflow pressures: Admissions, rounds, and high patient volumes limit opportunities for lengthy diagnostic conversations.
• Not every patient or situation is the same: SHARE-DX may be most useful in cases of diagnostic uncertainty, complex presentations, or patient-clinician misalignment rather than straightforward diagnoses.
• Balancing transparency with trust: Clinicians expressed concerns about discussing uncertainty without undermining patient confidence or creating confusion.
• Information overload: Some participants worried that sharing extensive differential diagnoses could overwhelm patients or lead to requests for low-value testing.
• Patient and family factors: Cognitive impairment, language barriers, varying health literacy, and differences in desired levels of engagement may require tailoring the approach.
• Implementation and culture change: Participants noted that adoption would likely require local champions, integration into existing workflows, and engagement of learners and early adopters.

"This is a tool that's specifically geared towards instances when there's diagnostic uncertainty."

Where SHARE-DX May Have the Greatest Impact

A strong consensus emerged that SHARE-DX should be used selectively rather than universally. Participants identified several situations where the framework may provide the greatest value:

• Diagnostic uncertainty
• Complex or multi-consultant cases
• Clinical deterioration or failure to improve as expected
• Diagnostic disagreement or misalignment between patients, families, and clinicians
• Communication breakdowns requiring trust rebuilding
• Care transitions and diagnostic reassessments

"I think this would do a lot for patient education, like to understand why we think what's going on."

Next Steps 

Participants emphasized that SHARE-DX should function as a flexible guide that can be adapted to the patient, clinical situation, and degree of diagnostic uncertainty rather than a rigid checklist. Many participants felt that successful implementation would require integration into existing workflows rather than introducing SHARE-DX as a standalone initiative. The discussion reinforced that the challenge is no longer whether diagnostic partnership matters, but how to operationalize it in busy clinical environments. Based on HOMERuN feedback, the SHARE-DX team is exploring refinements to the framework with patients, caregivers, hospitalists, and other members of the care team.

New Publications

A study by the HOMERuN Discharge and Transitions Committee highlights the challenges hospitals face in designing and organizing transitions of care programs. While disease-specific programs were viewed as effective, clinicians described a fragmented landscape in which programs are often developed around service lines or funding streams rather than patient needs. As a result, some patients may experience either insufficient support or duplicative outreach, highlighting a critical challenge for the field: determining how to organize and deploy evidence-based transitional care for older adults with complex, overlapping needs. These findings point to the next frontier in transitional care research—understanding how health systems can efficiently match the intensity and type of post-discharge support to individual patients.

Weerahandi H, Williams MV, Rosenthal MA, et al. Heterogeneity and misaligned incentives in discharge transition programs: Insights from a multisite rapid qualitative study. J Hosp Med. 2026;1-11.

Two studies related to the ADEPT Study were published in July.

Through focus groups with hospitalists from 23 institutions, the authors found that diagnostic excellence is supported by adaptive clinical reasoning, collaborative teamwork, and systems that protect diagnostic capacity, while also demonstrating that current health systems lack reliable ways to identify exemplary diagnostic performance. High-performing clinicians described deliberately revisiting hypotheses, embracing uncertainty, contingency planning, seeking informal second opinions, leveraging psychologically safe teams, and relying on technology and workflows that reduce cognitive burden rather than increase it. Together, these findings shift the focus from preventing diagnostic errors to intentionally designing environments that enable clinicians and teams to consistently diagnose well.

Raffel KE, Webber CJ, Narayanan M, Tozier M, Cerasale M, Lee TM, Burden M, Auerbach A, Schnipper JL, Keniston A. A multi-institutional rapid qualitative assessment of factors supporting diagnostic excellence in hospital medicine. J Hosp Med. 2026 Jul 10.

In this national survey of hospitalists, the authors found that informal peer diagnostic second opinions are common and are viewed as an important strategy for improving diagnostic reasoning. Hospitalists reported that these conversations are most valuable when they occur in a psychologically safe environment with trusted colleagues, but identified time pressure, workflow disruptions, and concerns about appearing incompetent as important barriers to seeking a second opinion. The findings suggest that hospitals could strengthen diagnostic safety by normalizing and supporting structured peer consultation as a routine part of inpatient care rather than relying solely on individual clinician expertise.

Miyagami T, Auerbach A, Schnipper JL, Ranji S, Barish P, Kantor MA, Dalal A, Lee T, Raffel KE; for the ADEPT Research Group. Informal peer diagnostic second opinion: Hospitalist practices and perspectives. J Hosp Med. 2026 Jul 6.

Our next HOMERuN meeting will be on August 7, 2026.

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