Diagnostic AI tops ECRI’s annual patient safety list

The growing use of artificial intelligence (AI) in clinical diagnosis is the top patient safety concern for 2026, according to an annual report released this month by ECRI, a global nonprofit patient safety organization.

The report, “Top 10 Patient Safety Concerns 2026,” introduced jointly by ECRI and the Institute for Safe Medication Practices, identifies 10 systemic threats to safe care in the United States. Along with AI risk, the list flags declining access to health care in rural communities, a resurgence of preventable diseases fueled by falling vaccination rates, and the downstream effects of federal funding cuts on hospital operations.

“Rural communities are losing access to essential health care services. At the same time, falling vaccination rates are driving a troubling rise in preventable diseases. Vaccines are foundational to patient safety, and we are seeing decades of hard-won progress in public health erode in the fight against diseases like measles and whooping cough,” said Marcus Schabacker, M.D., Ph.D., president and CE of ECRI. “Now more than ever, health care leaders must be proactive and creative to tackle these challenges.”

The AI diagnostic dilemma

AI’s placement at the top of ECRI’s list reflects a well-known tension for physicians across specialties: AI tools hold clear promise for improving diagnostic speed and accuracy, but deploying them without robust safeguards introduces new categories of risk.

According to ECRI, a survey of nearly 1,200 physicians found that approximately 66% reported using AI in 2024, up from 38% in 2023. Yet evidence for AI-driven diagnosis remains shaky, at best.

The report cites research showing that tested machine learning models failed to recognize 66% of critical or deteriorating health conditions in synthesized cases, and that popular generative AI tools saw their diagnostic accuracy drop significantly when prompts were based on open-ended patient conversations rather than textbook-style descriptions.

The liability dimension is also becoming harder to ignore. Richard Anderson, M.D., chairman and CEO of The Doctors Company and TDC Group, told Medical Economics that physicians face a genuine paradox.

"If AI makes a recommendation that's different than the standard of care, and the doctor follows it, and the outcome is actually adverse, then, by definition, the doctor has violated the standard of care," Anderson said. "Adoption of AI is actually going to be slowed by this paradox."

Anderson noted that more than 1,000 AI tools have already received validation from the U.S. Food and Drug Administration (FDA), but physicians have limited ability to evaluate which ones are reliable, how they interact with existing clinical ecosystems or what happens when the technology produces an incorrect answer.

"It's 100% certain that the technology that is integral to the practice of medicine today, which includes AI — the legal system will not keep up with that technology," he said.

For now, ECRI recommends that health care organizations establish clear AI usage policies, train clinicians on the capabilities and limitations of diagnostic AI systems and require documentation of instances in which AI influenced clinical decisions. The report urges organizations to view AI as a supplement to clinical expertise, not a replacement for it.

Mark Daly, chief technology officer of Digital Diagnostics, which holds the first FDA clearance for an autonomous AI diagnostic tool, offered a practical framing in a 2025 interview with Medical Economics. "Instead of having physicians wasting their time on activities that could be automated, we're having physicians do that," Daly said. "Letting folks really work at the top of their license or spend the most time with patients in meaningful encounters rather than going through big sorting exercises."

Rural access and a fraying safety net

The second concern on ECRI's list, reduced access to health care in rural communities, is not new, but it is intensifying.

Since 2005, 195 rural hospitals in the U.S. have either closed or converted away from inpatient services. Another 757 are at risk of closing, including 321 at immediate risk, according to data cited in the report. More than 80% of U.S. counties lack adequate access to pharmacies, primary care, hospitals, trauma centers or low-cost health centers.

Nearly half of rural hospitals are operating with negative patient service margins, and private insurance and federal reimbursement rates often do not cover the higher per-visit costs that come with serving smaller patient populations. Approximately 60% of primary medical, dental and mental health professional shortage areas are rural.

Peter Reilly, North American health care practice leader at HUB International, told Medical Economics that the situation is particularly acute for critical access hospitals and federally qualified health clinics. "Those providers often still provide some of the very best bedside medicine," Reilly said. "Rural health care is where so much health care is still delivered on a one-to-one, very personal basis." But financial headwinds are real, he added, and practitioners need to be working with their local, state and federal representatives to push for action.

Anderson drew a direct connection between consolidation and the access crisis. "Large corporations take over the distribution of many medical institutions, including hospitals, and many venues don't find it financially viable to operate a hospital in a rural area," he said. "About 60% of rural hospitals in the United States today no longer provide obstetrical care. That's an extraordinary gap."

Vizient's 2026 State of the Industry Report tells a similar story. Shannon Sims, M.D., Ph.D., FAMIA, Vizient's chief product officer, said that access has overtaken staffing as the defining operational challenge for hospital customers. "Coming out of the pandemic, staffing was the number one issue our customers told us about. Now we are hearing that access is the number one thing they are working on," Sims said. "To solve that, you have to embrace technology, new practice models like [advanced practice providers] and other nontraditional ways to boost access."

Preventable diseases resurge

ECRI's third concern, rising rates of preventable acute diseases, captures a problem that has been building for several years. The report notes that measles, one of the most contagious vaccine-preventable diseases, infected an estimated 20.6 million people globally in 2024. In the U.S., coverage with the measles, mumps and rubella (MMR) vaccine among kindergartners fell from 95.2% during the 2019-2020 school year to 92.7% during the 2023-2024 school year, dipping below the threshold needed to maintain herd immunity.

Pertussis, commonly known as whooping cough, has also made a sharp comeback — reported U.S. cases in 2024 were more than six times higher than in 2023, according to data from the U.S. Centers for Disease Control and Prevention (CDC), cited in the report. Changes to the CDC's recommended childhood vaccine schedule announced in January 2026 risk further eroding vaccination rates, ECRI warned.

The resurgence extends beyond vaccines. In January 2025, officials in Multnomah County, Oregon, reported 40 confirmed cases of dysentery, more than double the previous year, linked to inadequate sanitation among people experiencing homelessness. ECRI's report frames these outbreaks as symptoms of broader failures in public health infrastructure, misinformation and equitable access to preventive care.

Federal funding cuts and workforce strain

The fourth concern on ECRI's list is the effects of federal funding cuts on health care operations and patient safety.

In July 2025, Congress passed legislation that included reductions the Congressional Budget Office (CBO) estimated would cut Medicaid by nearly $1 trillion over the next decade, and Medicare by $491 billion from 2026 through 2034. The National Institutes of Health also terminated more than 1,000 grants to hospitals and medical schools.

The report notes that Medicaid is the largest source of revenue for community health centers, accounting for 42% of their operating revenue. Layoffs have already begun at several institutions. The cuts are expected to compound existing workforce shortages, ECRI's seventh concern on the list, which the report says are particularly acute in behavioral health, obstetrics, long-term care and Veterans Affairs (VA) settings.

More than half of U.S. health care workers expect to search for, interview for or switch jobs in 2026, according to a Reuters survey cited in the report.

Rihan Javid, D.O., J.D., a psychiatrist and co-founder of Edge, a remote staffing organization, says that the staffing challenge extends well beyond pay. "The answer isn't always just increasing salaries," Javid said. "You have to have a great work environment. You have to be employee-friendly. And really, what you want to do is you want to have a core workforce, whether that's in person or remote, that you know is going to be with you."

Javid noted that when turnover accelerates, the downstream effects compound quickly. Medication refills, prior authorizations, billing and patient check-in all start falling on physicians. "A lot of times it falls on the doctor to take care of," he said. "And we've seen all of that, including billing, where the doctors are doing that sometimes."

Underreporting and a ‘culture of blame’

Two related concerns round out ECRI's middle tier: a persistent failure to recognize and report patient-harm events (No. 5) and a “culture of blame” that discourages health care workers from speaking up about safety incidents (No. 8).

A July 2025 report from the U.S. Office of Inspector General found that participating hospital reporting systems captured only 51% of adverse events occurring in those facilities. Although that represents an improvement over a 2012 finding of just 14%, it means that roughly half of patient harm still goes unrecorded. The most common reason: 46% of unreported events were not considered to be harm because they were viewed as part of the normal course of care.

"When frontline clinicians do not feel psychologically safe reporting concerns, early warning signs of risk can be overlooked. Building resilient teams and fostering a workplace culture that encourages transparency and continuous learning are essential to reducing preventable harm," said Dheerendra Kommala, M.D., chief medical officer at ECRI.

The financial case for addressing these issues is substantial. ECRI's report cites research estimating that preventable adverse events in U.S. hospitals cost $17.1 billion annually, with an additional $4.6 billion attributable to clinician burnout.

The report frames patient safety not only as a moral imperative but as a financial one, noting that up to 12.6% of all health spending in high-income countries goes toward managing the consequences of unsafe care.

Inadequate pain management for women and other concerns

The report also spotlights structural and systemic barriers that inhibit equitable pain management for women, ranking the issue as the sixth patient safety concern for 2026.

Research cited in the report shows that gender bias leads clinicians to attribute women's pain to psychological or hormonal factors far more often than men's, even when physical causes are equally likely.

One study found that women were less likely to receive analgesics at every level of reported pain. Women of color face compounding disparities, with research indicating their pain is often significantly underestimated by clinicians during assessments, and that they are more likely to have pain dismissed during pregnancy and childbirth.

ECRI also flagged inconsistencies in clinical guidelines, noting that local anesthesia has been shown to reduce pain during hysteroscopies and intrauterine device insertions, yet is not consistently offered to women during these procedures.

The remaining concerns on the list include emergency room (ER) boarding, where an analysis of 46.2 million hospitalizations from 2017 to 2024 found that at its peak, more than 40% of patients boarded in the ER for more than four hours. The practice is associated with delayed care, higher morbidity, increased medication errors and greater violence against health care workers.

ECRI's 10th concern addresses persistent gaps in manufacturer medication packaging and labeling design, which have been identified as contributing factors in up to 29% of events reported to the ISMP National Medication Errors Reporting Program.

What’s next for patient safety in 2026 and beyond

What runs through all 10 of ECRI's concerns is a common thread: These are not isolated problems with isolated fixes. AI risk, rural closures, workforce shortages, funding cuts and disease resurgence are feeding into one another, compounding the pressure on a health care system that was already stretched thin before the COVID-19 pandemic.

A hospital that loses staff to burnout has fewer people to report safety events. A rural practice that closes its doors pushes patients into already overcrowded emergency room. A physician who cannot evaluate the AI tool embedded in their workflow is left to navigate liability risk with little guidance from the legal system.

The larger message is that incremental fixes applied to individual problems will not be enough. The challenges on this list are structural, and addressing them will require the kind of sustained institutional commitment that is difficult to maintain when margins are thin and the next crisis is always around the corner.

ECRI will hold a webinar on March 20, 2026, to discuss the report's findings alongside Patients for Patient Safety (PFPS) US, a nonprofit network of advocates led by individuals who have experienced medical error firsthand.