Electronic alerts do not necessarily ensure timely follow-up

Abnormal results on outpatient imaging tests sometimes may not receive timely follow-up even when clinicians receive and read results in an advanced, integrated electronic medical record system, according to a report in the Archives of Internal Medicine.

Hardeep Singh, MD, MPH, of Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, and his co-authors studied critical imaging alert notifications in an outpatient setting between November 2007 and June 2008. The researchers used tracking software to determine whether alerts about abnormal test results were read within two weeks, then reviewed medical records and contacted health-care practitioners to determine whether timely follow-up actions (such as ordering a follow-up test or consultation) were taken within four weeks of the alert transmission.

Results from 0.97 percent of the 123,638 x-rays, computed tomography [CT] scans, magnetic resonance imaging [MRI] and mammograms performed during the study period generated alerts to the ordering clinician. Of these alerts, 18.1 percent were not read or acknowledged. Alerts were more likely to be unacknowledged if the ordering clinician was a trainee or if an alert was sent to more than one clinician.

Timely follow-up of abnormal results did not occur following 7.7 percent of all alerts, including 7.3 percent of alerts that were acknowledged and 9.7 percent of alerts that were unacknowledged. This follow-up also was less likely to occur when more than one clinician received the alert, but it was more likely to occur when a radiologist also communicated concerns about the results verbally, either by phone or in person.

“Even in the best of information systems that contain advanced notification features, patients with abnormal imaging results are vulnerable to ‘falling through the cracks.’ This underscores the need for a multidisciplinary approach involving human-computer interaction and informatics to complement the benefits achieved by automated notification and the need for continuous monitoring procedures to ensure follow-up even when health care providers ‘acknowledge’ (i.e., read) abnormal results,” the authors wrote.