AI-fueled misdiagnoses, rural care barriers are 2026's top patient safety threats: ECRI

Misdiagnoses due to artificial intelligence and rural communities’ limited access to care should be front of mind for healthcare organizations looking to minimize preventable harm and improve patient outcomes in 2026, warned ECRI in a report released this week. 

The two issues were at the top of the healthcare safety group’s annual ranking of top patient safety concerns, which spanned a broad range of focus areas, including technology, public health, staffing, organizational culture and structural barriers to care. 

Regarding the forefront issue of “navigating the AI diagnostic dilemma,” ECRI pointed to a 2025 American Medical Association survey of nearly 1,200 physicians that showed the percentage who used AI had risen from 38% in 2023 to 66% in 2024. It also underscored peer-reviewed studies from the past couple of years in which tested machine learning models failed to consistently spot critical health conditions, struggled to maintain accuracy when prompts were based on simulated patient conversations, perpetuated biases introduced by training datasets and lowered the guard of clinicians who rely on such tools for diagnoses (referred to as “automation bias”).

“In order for AI to be used effectively in diagnosis, clinicians must view it as a tool designed to supplement and support clinical expertise—not replace it,” ECRI wrote in the report. “This requires a balanced approach to adoption, thoughtfully considering both the benefits and risks of AI to the diagnostic process. Clinicians who want to best utilize an AI system for diagnosis must be trained on the system’s proper use and must understand its capabilities and limitations.”

Landing behind AI diagnostics was a concern that healthcare deserts in rural communities are primed to worsen amid hospital closures, commonplace negative operating margins and impending federal healthcare funding cuts (which also warranted its own entry on ECRI’s list, at #4). The safety group emphasized that over 60% of primary care, dental and mental health professional shortage areas are rural. 

Such barriers can lead to delayed care, greater mortality and chronic disease, poorer health behaviors and lower life expectancy. To head these off, ECRI recommended organizations pursue innovative care models like telehealth and partnerships with community-based organizations, among other approaches. 

The full list of top patient safety concerns for 2026, in ranked order as laid out in the report, was: 

1. Navigating the AI diagnostic dilemma
2. Reduced access to rural healthcare increases health risks and disparities
3. Increasing rates of preventable acute diseases in communities and healthcare settings
4. Effects of federal funding cuts on healthcare operations and patient safety
5. Lack of recognition and reporting of harm events
6. Structural and systemic barriers inhibit equitable pain management for women
7. Persistent workforce shortages continue to burden staff and restrict access to care
8. The impact on system improvement when a culture of blame hinders learning
9. Emergency department boarding contributes to worse patient outcomes
10. Persistent gaps in manufacturer packaging and labeling design continues to undermine medication safety efforts

ECRI and its affiliate Institute for Safe Medication Practices (ISMP) built that annual list and report by having staff, the public and members nominate potential safety topics for evaluation. A cross-disciplinary team of experts from the groups reviewed available evidence for those topics and evaluated each on its severity, frequency, breadth, insidiousness (difficulty to recognize or rectify) and whether it would place pressure on an organization.

Accompanying each entry in the list are recommendations from the expert panels on how organizations can address the issues to avoid preventable patient harm. 

Alongside the inherent boon of improved patient outcomes, the group also noted that "there's an equally compelling financial argument" for organizations to pursue such issues—preventable adverse events run U.S. hospitals $17.1 billion each year, with clinician burnout costing another $4.6 billion.   

Last year’s version of the list was headlined by “medical gaslighting,” referring to instances when clinicians minimize the severity of a patient’s symptoms, ignore or interrupt patients, blame the patient and generally exhibit condescending behavior. In 2024, the group highlighted difficulties transitioning newly trained clinicians into a broader workforce decimated by pandemic departures and burnout. 

ECRI more recently released another report specifically flagging the most substantial health technology risks to patients and organizations. Topping that list was the rise and misuse of large language model-based chatbots (e.g., ChatGPT, Claude, Copilot, Gemini and Grok) that are not designed or regulated for healthcare purposes.