IHE Profile Proposal (Brief)

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1. Proposed Profile: <initial working name for profile>

Proposal Editor: Kevin O'Donnell
Date: N/A (Wiki keeps history)
Version: N/A (Wiki keeps history)
Domain: Radiology/Cardiology/IT/Path?/Lab?

2. The Problem

<Summarize the integration problem. What doesn’t work, or what needs to work.>

(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. )

(Taken from PACSWeb Article)

Referring clinicians failed to electronically acknowledge over one-third of abnormal imaging results in an outpatient setting, even when a computerized test result notification system designed to alert referring physicians was used, according to a paper from Texas. Providers were unaware of critical imaging results in 4% of cases as long as four weeks after reporting.

"Our findings suggest that a computerized test result notification system with standardized policies and procedures does not altogether prevent lack of physician awareness of abnormal imaging results and subsequent loss of appropriate follow-up," said lead author Dr. Hardeep Singh of the department of medicine at Baylor College of Medicine.

The study analyzed 1017 outcomes of abnormal imaging alerts in an ambulatory multispecialty clinic that were transmitted to providers via the electronic medical record but were not electronically acknowledged by the referring clinicians (J Am Med Inform Assoc 2007;14(4):459-466. Epub 2007 Apr 25).

Singh was unable to evaluate how follow-up rates may have improved with the implementation of the electronic notification system since data about abnormal report communication outcomes prior to using the electronic system are unavailable.

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. In response to the increased recognition that delayed communication in radiology is a major cause for litigation in the U.S., the American College of Radiology updated its guidelines for communicating critical diagnostic imaging findings in 2005.

Singh said their high tracking reliability allows electronic notification systems address two factors that can lead to malpractice claims against radiologists:

failure to directly contact the referring physician
failure to document any attempt to make contact

Providers face constraints such as time and workload that could affect the communication process, Singh said.

"Much needs to be learned about why abnormal test result alerts remain unacknowledged and why imaging results get lost to follow-up despite confirmed transmission to referring providers," he said. "Future work should address decreasing lost to follow-up results in computerized systems without placing additional burdens on providers." Although other automated test result notification systems are emerging, little is known about their performance and outcome. 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

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

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)?

<Try to keep the proposal to 1 or at most 2 pages>

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Critical Results - Brief Proposal