Wednesday, June 24, 2009

EHR Impact on Failure-To-Inform Rates

7.1% of patients are not notified of abnormal outpatient test results (or the notification is not documented) affecting 1 in 14 patients, with failure rates ranging as high as 1 in 4 patients in some practices. The health implications of this finding are significant.

The study led by Dr. Lawrence Casalino of Weill Cornell Medical College found that "having an electronic medical record did not reduce failure-to-inform rates — and even increased them — if the practice did not have good processes in place for managing test results... The study suggests that five simple, common-sense processes are useful for dealing with test results: (1) all test results are routed to the responsible physician; (2) the physician signs off on all results; (3) the practice informs patients of all results, normal and abnormal, at least in general terms; (4) the practice documents that the patient has been informed; and (5) patients are told to call after a certain time interval if they have not been notified."

The full study - "Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results" - in the Archives of Internal Medicine reports that "use of a 'partial electronic medical record' (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record or with having an electronic medical record that included both progress notes and test results. "

The authors concluded that "they did not find a significant difference between practices that had a 'complete' EMR and those that used paper records; this may be because there is no difference or because the number of practices included was not large enough to detect a difference."

1 comment:

Bob Coli, MD said...

There is an innovative way to solve the failure-to-inform problem for all diagnostic test results while enabling those results to be viewed and shared efficiently for the first time.

The solution is to standardize and clinically integrate the format that EHR, PHR and HIE platforms use to report test results to physicians and patients.

The existing variable formats are relics of the mainframe-computing era. They can display only fragmented data that is very difficult to read and analyze. An ergonomically correct redesign of the test results reporting format that will enhance physician work flow, instead of disrupting it, is long overdue.

Using a semantic and work flow type of interoperability clinical standard to significantly facilitate the viewing and sharing of test results will help achieve the HIT Policy Committee's meaningful use health outcomes policy priorities by improving care coordination, quality, safety and efficiency and by engaging patients and families.

It will also help responsible physicians and patients collaborate to cut unnecessary testing and control costs.