Critical Results - Brief Proposal: Difference between revisions
No edit summary |
|||
| Line 16: | Line 16: | ||
* Important incidental results such as findings that may threaten the patients life in the future (e.g. a suspicious lung mass in an exam for a cracked rib) should not be overlooked and must be properly followed up. | * Important incidental results such as findings that may threaten the patients life in the future (e.g. a suspicious lung mass in an exam for a cracked rib) should not be overlooked and must be properly followed up. | ||
In an era of increasing pressures to interpret more images in less time, most radiologists are unable to spend the significant amounts of time needed to track down referring physicians and personally communicate findings. | In an era of increasing pressures to interpret more images in less time, most radiologists are unable to spend the significant amounts of time needed to track down referring physicians and personally communicate findings. | ||
| Line 25: | Line 23: | ||
Failure to communicate with referring physicians is believed to be responsible for significant numbers of adverse outcomes, and it is often implicated in liability claims. | Failure to communicate with referring physicians is believed to be responsible for significant numbers of adverse outcomes, and it is often implicated in liability claims. | ||
There is currently no | There is currently no standard, integrated way to track receipt of clinical findings. The problem is compounded by the many different ways such findings can (and should) be communicated (particularly in urgent cases). | ||
==3. Key Use Case== | ==3. Key Use Case== | ||
Revision as of 00:34, 1 September 2007
1. Proposed Profile: Critical Results
- Proposal Editor: Kevin O'Donnell/Paul Nagy
- Date: N/A (Wiki keeps history)
- Version: N/A (Wiki keeps history)
- Domain: Radiology/Cardiology/IT/Path?/Lab?
2. The Problem
Typically a referring physician, suspecting a particular pathology, orders an imaging exam to confirm or rule it out or to provide more detail. Current report distribution mechanisms work reasonably well for communicating such results however gaps remain:
- Critical results such as findings that may imminently threaten the patients life (e.g. a pneumothorax) cannot wait for whenever the referring physician gets to the report but must need to be acted on quickly.
- Important incidental results such as findings that may threaten the patients life in the future (e.g. a suspicious lung mass in an exam for a cracked rib) should not be overlooked and must be properly followed up.
In an era of increasing pressures to interpret more images in less time, most radiologists are unable to spend the significant amounts of time needed to track down referring physicians and personally communicate findings.
However, the American College of Radiology has made clear in its practice guidelines that not only is such notification necessary, but that documented, verifiable records of such communication must be retained by the radiologist. Dozens of legal decisions have found radiologists responsible for damages in cases in which imaging results and reports were not communicated or in many cases in which such communications could not be verified.
Failure to communicate with referring physicians is believed to be responsible for significant numbers of adverse outcomes, and it is often implicated in liability claims.
There is currently no standard, integrated way to track receipt of clinical findings. The problem is compounded by the many different ways such findings can (and should) be communicated (particularly in urgent cases).
3. Key Use Case
A number of well attended presentations at SIIM 2007 emphasized the significance of this problem and presented desired behaviors.
Address notification that critical results exist, access to those critical results, and auditing notification/receipt of notification/receipt of results
(Need to work in discussions from SIIM, for example the multiple levels of urgency and correspondingly different notification channels appropriate to the urgency, as has been done at several institutions already. )
<Feel free to add a second use case scenario demonstrating how it “should” work. Try to indicate the people/systems, the tasks they are doing, the information they need, and hopefully where the information should come from.>
4. Standards & Systems
<List existing systems that are/could be involved in the problem/solution.>
<If known, list standards which might be relevant to the solution>
Paul Nagy and others have suggested that many of the relevant events already can be logged in the IHE ATNA audit log. Additional relevant events could easily be added. If this profile added a query interface to the Audit Repository, it could be an excellent mechanism for tracking/confirming notification and receipt of necessary information.
5. Discussion
<Indicate why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>
This topic has been raised before in Radiology and was referred to IT Infrastructure, however there has been no progress there. Should we renew pressure on them, or consider drafting a profile ourselves for transfer later (as was done with ATNA in the first place)?
"Future work should address decreasing lost to follow-up results in computerized systems without placing additional burdens on providers." In general, computerized alerts have been shown to improve the communication of critical lab results in the inpatient setting, Singh said.
"We believe electronic alerting systems have a promising future in improving response to abnormal imaging results in the outpatient setting," he said
<Try to keep the proposal to 1 or at most 2 pages>