Download PDF
Appl Clin Inform 2018; 09(02): 411-421
DOI: 10.1055/s-0038-1654700
Research Article
Schattauer

Semiautomated System for Nonurgent, Clinically Significant Pathology Results

Stacy D. O'Connor
1   Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Ramin Khorasani
1   Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Stephen M. Pochebit
2   Department of Pathology, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, United States
,
Ronilda Lacson
1   Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Katherine P. Andriole
1   Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Anuj K. Dalal
3   Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding This work was partially supported by grants from the Controlled Risk Insurance Company Risk Management Foundation and the Boston Area Research Training Program in Biomedical Informatics (National Library of Medicine (NLM) grant T15LM007092).
Further Information

Publication History

16 November 2017

13 April 2018

Publication Date:
06 June 2018 (online)

   Permissions and Reprints

Abstract

Background Failure of timely test result follow-up has consequences including delayed diagnosis and treatment, added costs, and potential patient harm. Closed-loop communication is key to ensure clinically significant test results (CSTRs) are acknowledged and acted upon appropriately. A previous implementation of the Alert Notification of Critical Results (ANCR) system to facilitate closed-loop communication of imaging CSTRs yielded improved communication of critical radiology results and enhanced adherence to institutional CSTR policies.

Objective This article extends the ANCR application to pathology and evaluates its impact on closed-loop communication of new malignancies, a common and important type of pathology CSTR.

Materials and Methods This Institutional Review Board-approved study was performed at a 150-bed community, academically affiliated hospital. ANCR was adapted for pathology CSTRs. Natural language processing was used on 30,774 pathology reports 13 months pre- and 13 months postintervention, identifying 5,595 reports with malignancies. Electronic health records were reviewed for documented acknowledgment for a random sample of reports. Percent of reports with documented acknowledgment within 15 days assessed institutional policy adherence. Time to acknowledgment was compared pre- versus postintervention and postintervention with and without ANCR alerts. Pathologists were surveyed regarding ANCR use and satisfaction.

Results Acknowledgment within 15 days was documented for 98 of 107 (91.6%) pre- and 89 of 103 (86.4%) postintervention reports (p = 0.2294). Median time to acknowledgment was 7 days (interquartile range [IQR], 3, 11) preintervention and 6 days (IQR, 2, 10) postintervention (p = 0.5083). Postintervention, median time to acknowledgment was 2 days (IQR, 1, 6) for reports with ANCR alerts versus 6 days (IQR, 2.75, 9) for reports without alerts (p = 0.0351). ANCR alerts were sent on 15 of 103 (15%) postintervention reports. All pathologists reported that the ANCR system positively impacted their workflow; 75% (three-fourths) felt that the ANCR system improved efficiency of communicating CSTRs.

Conclusion ANCR expansion to facilitate closed-loop communication of pathology CSTRs was favorably perceived and associated with significant improved time to documented acknowledgment for new malignancies. The rate of adherence to institutional policy did not improve.

Keywords

critical test results - pathology information systems - hospital communication systems - automated electronic alert notification - clinically significant test results

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the Brigham and Women's Institutional Review Board.


 

  • References

  • 1 Wahls T, Haugen T, Cram P. The continuing problem of missed test results in an integrated health system with an advanced electronic medical record. Jt Comm J Qual Patient Saf 2007; 33 (08) 485-492
    PubMedGoogle Scholar
  • 2 Wahls TL, Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract 2007; 8: 32
    CrossrefPubMedGoogle Scholar
  • 3 Gandhi TK, Kachalia A, Thomas EJ. , et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006; 145 (07) 488-496
    CrossrefPubMedGoogle Scholar
  • 4 Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011; 20 (02) 194-199
    CrossrefPubMedGoogle Scholar
  • 5 Singh H, Thomas EJ, Mani S. , et al. Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential?. Arch Intern Med 2009; 169 (17) 1578-1586
    CrossrefPubMedGoogle Scholar
  • 6 National Patient Safety Goals | Joint Commission. Available at: http://www.jointcommission.org/standards_information/npsgs.aspx . Accessed April 22, 2016
    PubMed
  • 7 Roy CL, Rothschild JM, Dighe AS. , et al. An initiative to improve the management of clinically significant test results in a large health care network. Jt Comm J Qual Patient Saf 2013; 39 (11) 517-527
    PubMedGoogle Scholar
  • 8 Singh H, Arora HS, Vij MS, Rao R, Khan MM, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc 2007; 14 (04) 459-466
    CrossrefPubMedGoogle Scholar
  • 9 Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and procedures: a college of American Pathologists Q-Probes Study in 623 institutions. Arch Pathol Lab Med 2002; 126 (06) 663-669
    CrossrefPubMedGoogle Scholar
  • 10 Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med 2007; 167 (19) 2030-2036
    CrossrefPubMedGoogle Scholar
  • 11 Greenberg CC, Regenbogen SE, Studdert DM. , et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg 2007; 204 (04) 533-540
    CrossrefPubMedGoogle Scholar
  • 12 Poon EG, Haas JS, Louise Puopolo A. , et al. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med 2004; 19 (04) 316-323
    CrossrefPubMedGoogle Scholar
  • 13 Roy CL, Poon EG, Karson AS. , et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med 2005; 143 (02) 121-128
    CrossrefPubMedGoogle Scholar
  • 14 Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med 2005; 142 (05) 352-358
    CrossrefPubMedGoogle Scholar
  • 15 Parl FF, O'Leary MF, Kaiser AB, Paulett JM, Statnikova K, Shultz EK. Implementation of a closed-loop reporting system for critical values and clinical communication in compliance with goals of the joint commission. Clin Chem 2010; 56 (03) 417-423
    CrossrefPubMedGoogle Scholar
  • 16 Lacson R, O'Connor SD, Andriole KP, Prevedello LM, Khorasani R. Automated critical test result notification system: architecture, design, and assessment of provider satisfaction. Am J Roentgenol 2014; 203 (05) 491-496
    PubMedGoogle Scholar
  • 17 Lacson R, Prevedello LM, Andriole KP. , et al. Four-year impact of an alert notification system on closed-loop communication of critical test results. Am J Roentgenol 2014; 203 (05) 933-938
    CrossrefPubMedGoogle Scholar
  • 18 Anthony SG, Prevedello LM, Damiano MM. , et al. Impact of a 4-year quality improvement initiative to improve communication of critical imaging test results. Radiology 2011; 259 (03) 802-807
    CrossrefPubMedGoogle Scholar
  • 19 Lacson R, O'Connor SD, Sahni VA. , et al. Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis. BMJ Qual Saf 2016; 25 (07) 518-524
    CrossrefPubMedGoogle Scholar
  • 20 O'Connor SD, Dalal AK, Sahni VA, Lacson R, Khorasani R. Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?. J Am Med Inform Assoc 2016; 23 (02) 333-338
    CrossrefPubMedGoogle Scholar
  • 21 Lacson R, Andriole KP, Prevedello LM, Khorasani R. Information from Searching Content with an Ontology-Utilizing Toolkit (iSCOUT). J Digit Imaging 2012; 25 (04) 512-519
    CrossrefPubMedGoogle Scholar
  • 22 Lacson R, Sugarbaker N, Prevedello LM. , et al. Retrieval of radiology reports citing critical findings with disease-specific customization. Open Med Inform J 2012; 6: 28-35
    CrossrefPubMedGoogle Scholar
  • 23 Gershanik EF, Lacson R, Khorasani R. Critical finding capture in the impression section of radiology reports. AMIA Annu Symp Proc 2011; 2011: 465-469
    PubMedGoogle Scholar
  • 24 Warden GI, Lacson R, Khorasani R. Leveraging terminologies for retrieval of radiology reports with critical imaging findings. AMIA Annu Symp Proc 2011; 2011: 1481-1488
    PubMedGoogle Scholar
  • 25 El-Kareh R, Roy C, Williams DH, Poon EG. Impact of automated alerts on follow-up of post-discharge microbiology results: a cluster randomized controlled trial. J Gen Intern Med 2012; 27 (10) 1243-1250
    CrossrefPubMedGoogle Scholar
  • 26 Dalal AK, Roy CL, Poon EG. , et al. Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial. J Am Med Inform Assoc 2014; 21 (03) 473-480
    CrossrefPubMedGoogle Scholar
  • 27 Harrison AM, Thongprayoon C, Aakre CA. , et al. Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting. PeerJ 2017; 5: e3083
    CrossrefPubMedGoogle Scholar
  • 28 Kuperman GJ, Teich JM, Tanasijevic MJ. , et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999; 6 (06) 512-522
    CrossrefPubMedGoogle Scholar
  • 29 Dalal AK, Schaffer A, Gershanik EF. , et al. The impact of automated notification on follow-up of actionable tests pending at discharge: a cluster-randomized controlled trial. J Gen Intern Med 2018; DOI: 10.1007/s11606-018-4393-y.
    CrossrefPubMedGoogle Scholar
  • 30 Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. “I wish I had seen this test result earlier!”: dissatisfaction with test result management systems in primary care. Arch Intern Med 2004; 164 (20) 2223-2228
    CrossrefPubMedGoogle Scholar
  • 31 Kwan JL, Cram P. Do not assume that no news is good news: test result management and communication in primary care. BMJ Qual Saf 2015; 24 (11) 664-666
    CrossrefPubMedGoogle Scholar
  • 32 Menon S, Murphy DR, Singh H, Meyer AND, Sittig DF. Workarounds and test results follow-up in electronic health record-based primary care. Appl Clin Inform 2016; 7 (02) 543-559
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Renshaw A, Gould EW. Quality assurance measures for critical diagnoses in anatomic pathology. Am J Clin Pathol 2012; 137 (03) 466-469
    CrossrefPubMedGoogle Scholar