Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: Are electronic medical records achieving their potential?

Archives of Internal Medicine

Volumn 169, Issue 17, 2009, Pages 1578-1586

  Singh, Hardeep ^a,b,e   Thomas, Eric J ^c   Mani, Shrinidi ^a,b   Sittig, Dean ^d   Arora, Harvinder ^b   Espadas, Donna ^a,b   Khan, Myrna M ^a,b   Petersen, Laura A ^a,b  

^a DEPARTMENT OF VETERANS AFFAIRS   (United States)

^b BAYLOR COLLEGE OF MEDICINE   (United States)

^c UNIVERSITY OF TEXAS MEDICAL SCHOOL   (United States)

^d UNIVERSITY OF TEXAS   (United States)

^e MICHAEL E DEBAKEY VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AUTOMATION; COMPUTER ASSISTED TOMOGRAPHY; COMPUTER PROGRAM; DIAGNOSTIC IMAGING; DIAGNOSTIC TEST; ECHOGRAPHY; ELECTRONIC MEDICAL RECORD; FOLLOW UP; HEALTH CARE PERSONNEL; HUMAN; IMAGE ANALYSIS; MAMMOGRAPHY; MEDICAL RECORD REVIEW; MULTIVARIATE LOGISTIC REGRESSION ANALYSIS; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTCOME ASSESSMENT; OUTPATIENT CARE; OUTPATIENT DEPARTMENT; PREDICTIVE VALIDITY; PRIORITY JOURNAL; RADIOGRAPHY; STATISTICAL ANALYSIS; VERBAL COMMUNICATION;

COMMUNICATION; CONTINUITY OF PATIENT CARE; DIAGNOSTIC IMAGING; HOSPITALS, VETERANS; HUMANS; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; OUTPATIENT CLINICS, HOSPITAL; PHYSICIAN'S PRACTICE PATTERNS; PROCESS ASSESSMENT (HEALTH CARE); RADIOLOGY; REMINDER SYSTEMS; RETROSPECTIVE STUDIES; TIME FACTORS;

EID: 70349778134     PISSN: 00039926     EISSN: 15383679     Source Type: Journal    
DOI: 10.1001/archinternmed.2009.263     Document Type: Article

References (42)

1. Joint Commission Resources Staff, Joint Commission on Accreditation of Healthcare Organizations Inc. The Physician's Promise: Protecting Patients from Harm. Chicago, IL: Joint Commission Resources; 2002.
2. Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401-407. (Pubitemid 41820063)
3. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165(13):1493-1499.
4. Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204 (4):533-540.
5. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831-841. (Pubitemid 46333948)
6. 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. (Pubitemid 350036701)
7. Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142(5):352-358.
8. 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.
9. Poon EG, Haas JS, Louise Puopolo A, et al. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19(4):316-323.
10. Schiff GD. Introduction: communicating critical test results. Jt Comm J Qual Patient Saf. 2005;31(2):63-65, 61.
11. Hickner J, Graham DG, Elder NC, et al. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Qual Saf Health Care. 2008;17(3):194-200.
12. Singh H, Petersen LA, Thomas EJ. Understanding diagnostic errors in medicine: a lesson from aviation. Qual Saf Health Care. 2006;15(3):159-164. (Pubitemid 43917345)
13. Singh H, Naik A, Rao R, Petersen L. Reducing diagnostic errors through effective communication: harnessing the power of information technology. J Gen Intern Med. 2008;23(4):489-494.
14. Singh H, Arora HS, Vij MS, Rao R, Khan M, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14(4):459-466. (Pubitemid 46970824)
15. Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104-112. (Pubitemid 38327498)
16. Choksi VR, Marn CS, Bell Y, Carlos R. Efficiency of a semiautomated coding and review process for notification of critical findings in diagnostic imaging. AJR Am J Roentgenol. 2006;186(4):933-936. (Pubitemid 46100190)
17. 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(8):485-492.
18. 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.
19. Kuperman GJ, Teich JM, Bates DW, et al. Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system. Proc AMIA Annu Fall Symp. 1996:704-708.
20. van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138-147. (Pubitemid 43332904)
21. Taylor LK, Tamblyn R. Reasons for physician non-adherence to electronic drug alerts. Stud Health Technol Inform. 2004;107(pt 2):1101-1105.
22. Magnus D, Rodgers S, Avery AJ. GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther. 2002;27(5):377-382. (Pubitemid 35286237)
23. Feldstein A, Simon SR, Schneider J, et al. How to design computerized alerts to safe prescribing practices. Jt Comm J Qual Saf. 2004;30(11):602-613.
24. Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003; 36(1-2):80-91. (Pubitemid 37206393)
25. VA Information Resource Center. Veterans Health Information Systems and Technology Architecture (VistA) - Description. 2007. http://www.virec.research. va .gov/DataSourcesName/VISTA/VISTA.htm. Accessed January 25, 2007.
26. Institute of Medicine of the National Academies. Patient Safety: Achieving a New Standard for Care. Washington, DC: National Academy Press; 2004.
27. Hickner JM, Fernald DH, Harris DM, Poon EG, Elder NC, Mold JW. Issues and initiatives in the testing process in primary care physician offices. Jt Comm J Qual Patient Saf. 2005;31(2):81-89.
28. Horsky J, Zhang J, Patel VL. To err is not entirely human: complex technology and user cognition. J Biomed Inform. 2005;38(4):264-266. (Pubitemid 41097402)
29. Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. 2006;15(suppl 1):i50-i58. (Pubitemid 46009830)
30. Kushniruk AW, Patel VL. Cognitive evaluation of decision making processes and assessment of information technology in medicine. Int J Med Inform. 1998; 51(2-3):83-90. (Pubitemid 28454526)
31. Cram P, Rosenthal GE, Ohsfeldt R, Wallace RB, Schlechte J, Schiff GD. Failure to recognize and act on abnormal test results: the case of screening bone densitometry. Jt Comm J Qual Patient Saf. 2005;31(2):90-97.
32. Gandhi TK, Sequist TD, Poon EG, et al. Primary care clinician attitudes towards electronic clinical reminders and clinical practice guidelines. AMIA Annu Symp Proc. 2003:848.
33. Murff HJ, Gandhi TK, Karson AK, et al. Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems. Int J Med Inform. 2003;71(2-3):137-149.
34. Wei EK, Ryan CT, Dietrich AJ, Colditz GA. Improving colorectal cancer screening by targeting office systems in primary care practices: disseminating research results into clinical practice. Arch Intern Med. 2005;165(6):661-666.
35. Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3(1):19-30.
36. Freeman HP. Patient navigation: a community centered approach to reducing cancer mortality. J Cancer Educ. 2006;21(1)(suppl):S11-S14.
37. Ell K, Vourlekis B, Lee PJ, Xie B. Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev Med. 2007; 44(1):26-33. (Pubitemid 46073077)
38. Battaglia TA, Roloff K, Posner MA, Freund KM. Improving follow-up to abnormal breast cancer screening in an urban population: a patient navigation intervention. Cancer. 2007;109(2)(suppl):359-367. (Pubitemid 46106220)
39. Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol. 2007;25(31):5009- 5018. (Pubitemid 350220435)
40. Bates DW, Leape LL. Doing better with critical test results. Jt Comm J Qual Patient Saf. 2005;31(2):61, 66-67.
41. Kuperman GJ, Hiltz FL, Teich JM. Advanced alerting features: displaying new relevant data and retracting alerts. Proc AMIA Annu Fall Symp. 1997:243-247.
42. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765. (Pubitemid 40522338)