Critical Finding Follow-up and Communication

1. Proposed Workitem: Critical Finding Follow-up and Communication

Proposal Editor: Felicha Candelaria-Cook, Michael Kopinsky, Amy Wang, Deb Woodcock (OHSU BMI516 Su2015 team 3, Harry Solomon, instructor)
Editor: tbd
Domain: Radiology

2. The Problem

If a patient does not have a regular physician, or is seen in multiple locations while receiving care, the results of his/her radiologic studies may be lost to follow-up. Radiology reports comprise large blocks of narrative, captured as free text or dictation. Critical findings recorded in this way are difficult to track and are not machine readable, and therefore are difficult to prioritize for action.

As a result, patients are being lost to follow-up, resulting in delayed diagnoses, preventable deaths, and malpractice lawsuits. There have been several cases in which patients have been seen at a hospital only to be later diagnosed with terminal cancer somewhere else.

We propose to address this problem by standardizing key findings and recommendations so they may be structured and integrated into follow-up workflows. This will enable this critical information to be tracked and prioritized for action.

3. Key Use Case

Current Situation: A radiologist documents a suspicious finding in a text report for an imaging study. Paper and electronic copies of reports are sent out, but the patient is lost to follow-up and later diagnosed with advanced cancer. The patient dies from a potentially treatable cancer.

Ideal Situation: The radiologist documents suspicious findings using a form that supports text narrative but that requires structured documentation using terms mapped to standard reference terminologies. Documenting a critical event requiring follow-up or selecting a term mapped to a standard reference terminologies and in a critical event value set triggers an event tracker within the EHR system. The event tracker creates a critical event with a defined workflow for follow-up and disposition based on the suspicious findings. The timing and urgency for follow-up are based on a the level of criticality as defined in the critical event value set. The event tracker creates a level 3 CDA document with the critical event which can be sent to other systems, such as other EHR modules and outside EHRs. The tracker sends information about the event to one or more designated notification receivers, which include the hospital’s critical evsuspent team, ordering physician, and the patient’s primary care physician, if available. If appropriate follow-up or disposition does not occur within a defined time period, then the event is escalated, triggering more urgent communication. The documented and coded findings are also sent to the hospital’s clinical decision support system, if available, triggering appropriate care pathways. The critical findings are automatically added to a registry of critical findings.

4. Standards and Systems

Relevant systems: Electronic health record (EHR), radiology information system (RIS), clinical decision support system (CDS)

Relevant components of standards: FHIR, SNOMED CT, LOINC, HL7 messaging, CDA

5. Discussion

This is an initial draft placeholder. Updated version to be developed during class seminar August 17-21.