Singh H, Thomas EJ, Mani S, Sittig D, Arora H, Espadas D, Khan MM, Petersen LA. Timely Follow-up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential? [Internet]. Arch Intern Med 2009 Sep;169(17):1578-1586.[cited 2009 Sep 29 ]
On the heels of a recent study demonstrating problems with patients receiving notification of abnormal lab test results, this study offers more insight in the area of diagnostic imaging results. And…the problems are just as concerning. Tip of the blog post, by the way, to Anita Samarth, who tweeted these findings initially to me.
When talking about “imaging results,” we’re referring to things like chest x-rays, CT scans, and MRI scans. These are often ordered to check for the possibility of cancer.
In fact, 11 times, results that were not relayed to patients after 4 weeks were of an abnormality that turned out to be cancer.
The interesting difference between this study and the study referenced previously is that it was done in a setting with a robust electronic health record (EHR) – The Department of Veterans Affairs.
What was studied was whether the (well) functioning EHR resulted in patients learning of abnormal imaging studies, not whether there was a working process to have these results brought to the attention of doctor in the first place.
The results are similar to those seen previously – Of 123,638 outpatient studies, 1,196 results were flagged “critical. 92 of these 1,196 critical notifications, or 7.7 %, did not result in timely notification, defined as 4 weeks. I’d say many patients and their families would not even classify “timely” as 4 weeks.
So the news is not very good with our ability to involve patients and families in their imaging results, either.
One other tidbit that caught my eye related to all of this is that if two doctors were involved in the notification instead of one, there was a greater likelihood of an alert not being acknowledged. That difference disappeared, though, when it came to looking for follow-up in the chart.
The issue of accountability leads me to what impressed me about this paper, and sort of not in a good way. There is no discussion of the potential for patients to assist in timely notification by having access to their imaging results online. This is especially surprising considering that the Department of Veterans Affairs manages a very good patient online access portal, MyHealthEVet.
Was this an oversight (not considering patient access as a solution), was this approach considered but not discussed in the article, or was this approach not considered a good solution at all?
As mentioned in a post on the Disruptive Women in Healthcare blog, it is the patient who will “care more about it or own it” the most when it comes to medical information. This is especially true, I think, when multiple clinicians are involved.
I have discussed the value of providing imaging test results to patients here previously – Several organizations already do this, including Beth Israel Deaconness Medical Center, and Palo Alto Medical Foundation.
Why not have this a standard (patient access), if we now know that in even the most technologically advanced systems, failure of notification can happen, and can potentially be devastating?