Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

OBJECTIVE To assess whether integrating critical result management software--Alert Notification of Critical Results (ANCR)--with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). MATERIALS AND METHODS This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts ("alerts") within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. RESULTS Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). CONCLUSIONS Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts.

[1]  E. Hing,et al.  Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. , 2014, NCHS data brief.

[2]  Anuj K. Dalal,et al.  Lessons learned from implementation of a computerized application for pending tests at hospital discharge. , 2011, Journal of hospital medicine.

[3]  Elisabeth Burdick,et al.  Communication factors in the follow-up of abnormal mammograms , 2004, Journal of General Internal Medicine.

[4]  C. Marn,et al.  Efficiency of a semiautomated coding and review process for notification of critical findings in diagnostic imaging. , 2006, AJR. American journal of roentgenology.

[5]  Lisa P. Newmark,et al.  Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record , 2015, J. Am. Medical Informatics Assoc..

[6]  Katherine P Andriole,et al.  Automated critical test result notification system: architecture, design, and assessment of provider satisfaction. , 2014, AJR. American journal of roentgenology.

[7]  J. Henry,et al.  Adoption of Electronic Health Record Systems among U . S . Non-Federal Acute Care Hospitals : 2008-2015 , 2013 .

[8]  Rathachai Kaewlai,et al.  Important imaging finding e-mail alert system: experience after 3 years of implementation. , 2009, Radiology.

[9]  D. Blumenthal.  Launching HITECH. , 2010, The New England journal of medicine.

[10]  Dean F. Sittig,et al.  Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential? , 2009, Archives of internal medicine.

[11]  Michael M Maher,et al.  Communication of unexpected and significant findings on chest radiographs with an automated PACS alert system. , 2014, Journal of the American College of Radiology : JACR.

[12]  Mitchell D Schnall,et al.  Assessment of follow-up completeness and notification preferences for imaging findings of possible cancer: what happens after radiologists submit their reports? , 2014, Academic radiology.

[13]  Katherine P Andriole,et al.  Four-year impact of an alert notification system on closed-loop communication of critical test results. , 2014, AJR. American journal of roentgenology.

[14]  Hardeep Singh,et al.  Eight recommendations for policies for communicating abnormal test results. , 2010, Joint Commission journal on quality and patient safety.

[15]  F. Mostashari.  Office of the National Coordinator for Health Information Technology Attention: Governance RFI , 2005 .

[16]  Kei Yamada,et al.  Electronic messaging system for communicating important, but nonemergent, abnormal imaging results. , 2010, Radiology.

[17]  Ramin Khorasani,et al.  An initiative to improve the management of clinically significant test results in a large health care network. , 2013, Joint Commission journal on quality and patient safety.

[18]  J. Benneyan,et al.  Statistical process control as a tool for research and healthcare improvement , 2003, Quality & safety in health care.

[19]  Andreas Laupacis,et al.  Non-adherence to recommendations for further testing after outpatient CT and MRI. , 2010, The American journal of medicine.

[20]  David W. Bates,et al.  Design and implementation of a comprehensive outpatient Results Manager , 2003, J. Biomed. Informatics.

[21]  Justin Dickerson,et al.  Follow-up of incidental pulmonary nodules and the radiology report. , 2014, Journal of the American College of Radiology : JACR.

[22]  Ramin Khorasani.  Optimizing communication of critical test results. , 2009, Journal of the American College of Radiology : JACR.