Test results acknowledgement system gets a perfect response

A study of an electronic test result acknowledgement system in use at a hospital in Brisbane has shown that of the thousands of tests conducted over a year, all of the test results were viewed by clinicians, the majority within 24 hours.

While the study could not be compared to rates of viewing or follow-up before the introduction of the system, it does show that health IT has the potential to reduce the amount of delayed or unreviewed results.

The study, led by Andrew Georgiou and Johanna Westbrook from the Centre for Health Systems and Safety Research at the University of NSW's Australian Institute of Health Innovation, looked at the introduction of a results acknowledgement (RA) system through IP Health's Verdi software.

First developed and used at the Peter MacCallum Cancer Centre in Melbourne, the Verdi suite is also used by the Mater Health Group's three hospitals in Brisbane. (Telstra announced in June last year that it had invested in IP Health in one of the telco's first forays into the eHealth market.)

The new study, published last week in the Journal of the American Medical Informatics Association (JAMIA), was conducted in the 249-bed Mater Mothers' Hospital from data collected between August 2011 and August 2012.

Mater implemented Verdi at Mater Adults, Mater Children's and Mater Mothers' between 2008 and 2012 as the first step towards providing an EMR for Mater clinicians. Verdi provides a portal to view data extracted from 15 separate systems and enabled the development of an RA system to allow clinicians to electronically document their reviews of test results. The RA solution was developed in-house using .Net web services.

Mater Mothers' uses an electronic request form (ERF) for ordering results through Verdi, but as the pathology and imaging department systems do not interface with the results acknowledgement system, a hard copy of the ERF is printed out and sent to the lab or radiology.

Sara Graham, a senior project manager with Mater Health and a co-author of the study, said the organisation was currently working with the pathology service provider to automate this process.

“The hard copy of the electronic request form (ERF) does currently need to be printed to go with the specimen/patient to the service provider,” Ms Graham said. “On receipt of the form though, the barcode is scanned in by the provider.

“The barcode contains the unique identifier which is then associated manually with the patient in the service provider system and the details of the test are entered manually. An HL7 message is then returned from the provider system to the clinical data repository with the unique identifier on the report, which allows RA to occur.”

She said the hospital's pathology and radiology systems do not currently receive an HL7 message with the test order data, but it is sent back via HL7 to the clinical data repository (CDR). The CDR is a Caché database from InterSystems, which underpins the clinical portal.

“This is where the match then happens with the report and all the data required to create an unacknowledged list of results to display to the Verdi user,” she said.

Ms Graham said Mater Health knew when setting up the system that it was an interim step to full automation, but decided to undertake it anyway due to the patient safety benefits the hospital is now achieving.

When the test result is ready, it is displayed in Verdi. Results are then acknowledged by the responsible clinician, who just needs to tick a box in the system. If the result is not electronically acknowledged within three days, email or pager alerts are sent out.

The idea is to overcome the problem of delayed or incomplete test result follow-up, which the authors say is an area of continuing patient safety concern for hospitals around the world.

They point to a 2011 report from the NSW Clinical Excellence Commission, which found that 11 per cent of incidents with a serious outcome such as patient death and 32 per cent of clinical incidents with major patient-related consequence, such as loss of bodily function, were associated with results that were either delayed or not reviewed.

The study looked at a year's worth of hospital data to measure clinicians' acknowledgement practices. It found that of the 27,354 inpatient test results for 6855 patients, all test results were acknowledged.

Of those acknowledgements, 60 per cent of laboratory results and 44 per cent of imaging results were acknowledged within 24 hours.

They found that the median time between report availability and acknowledgement was 18.1 hours for laboratory and 36 hours for imaging results. The median time from when a result was first viewed to its acknowledgement was seven minutes for laboratory and one minute for imaging results.

While the longest recorded time to acknowledgement was 38 days, all results were acknowledged, which is understood to be rare in paper-based systems. The researchers conclude that electronic results acknowledgement provides a safety net to enhance test result management.

“The RA system complements existing medical imaging and laboratory department procedures which require direct phone notification to the referring clinician of a life threatening or significantly abnormal result,” the authors write.

There were some significant differences in test acknowledgement rates by patient DRG category and by the day of the week. For example, obstetric or cancer-related test results were acknowledged faster than others, and the percentage of pathology results with an acknowledgement outside of three days was significantly higher on Fridays than other days.

However, “the findings of this study show that after the implementation of the RA system, all inpatient test results within the hospital were recorded as acknowledged, a result never previously reported from reviews of test follow-up using paper-based systems,” they write.

“The electronic RA system provides a safety net to ensure that all results can be monitored in real-time, representing a significant advance on previous test management practices, which often relied on time consuming retrospective paper-based audits to monitor, identify, and rectify problems.”

The study's limitations were that it does not include data on the prevalence of unacknowledged test results prior to the establishment of the RA system, which they say would have provided a valuable baseline comparison.

It was also unable to investigate clinical actions after reviewing results, but that Mater Health Service is planning to address this in the future.

Dr Georgiou said his colleagues at the Centre for Health Systems and Safety Research would very much welcome the opportunity to undertake follow-up studies to help the Mater investigate clinical actions after receiving the results, or do a study on clinical attitudes to the RA system.

The study is available online at the JAMIA website.

Posted in Australian eHealth

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