The Need for Closed-Loop Systems for Management of Abnormal Test Results
Authors: Gianna Zuccotti, Lipika Samal, Francine L. Maloney, Angela Ai, Adam Wright
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions5 June 2018The Need for Closed-Loop Systems for Management of Abnormal Test ResultsGianna Zuccotti, MD, Lipika Samal, MD, MPH, Francine L. Maloney, MPH, Angela Ai, BA, and Adam Wright, PhDGianna Zuccotti, MDBrigham and Women's Hospital, Harvard Medical School, and Partners HealthCare, Boston, Massachusetts (G.Z., L.S., A.W.), Lipika Samal, MD, MPHBrigham and Women's Hospital, Harvard Medical School, and Partners HealthCare, Boston, Massachusetts (G.Z., L.S., A.W.), Francine L. Maloney, MPHAriadne Labs at Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.L.M.), Angela Ai, BABrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.A.), and Adam Wright, PhDBrigham and Women's Hospital, Harvard Medical School, and Partners HealthCare, Boston, Massachusetts (G.Z., L.S., A.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2425 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Timely and appropriate follow-up of abnormal test results is essential (1, 2); however, the volume of results that physicians—particularly primary care providers—manage is staggering (3–5). Typical primary care providers review almost 900 diagnostic test results each week and spend an average of 74 minutes each day managing results (6). Most results are normal and do not require follow-up, but abnormal results must be recognized and follow-up actions completed to avoid potentially devastating clinical consequences (1). One survey conducted in the outpatient setting found that 78% of trainees were unable to follow up on test results at times and 65% had ...References1. Callen JL, Westbrook JI, Georgiou A, Li J. Failure to follow-up test results for ambulatory patients: a systematic review. J Gen Intern Med. 2012;27:1334-48. [PMID: 22183961] CrossrefMedlineGoogle Scholar2. Giardina TD, King BJ, Ignaczak AP, Paull DE, Hoeksema L, Mills PD, et al. Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. Health Aff (Millwood). 2013;32:1368-75. [PMID: 23918480] doi:10.1377/hlthaff.2013.0130 CrossrefMedlineGoogle Scholar3. Singh H, Thomas EJ, Mani S, Sittig D, Arora H, Espadas D, et al. Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential? Arch Intern Med. 2009;169:1578-86. [PMID: 19786677] doi:10.1001/archinternmed.2009.263 CrossrefMedlineGoogle Scholar4. Wahls TL, Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract. 2007;8:32. [PMID: 17519017] CrossrefMedlineGoogle Scholar5. Lin JJ, Dunn A, Moore C. Follow-up of outpatient test results: a survey of house-staff practices and perceptions. Am J Med Qual. 2006;21:178-84. [PMID: 16679437] CrossrefMedlineGoogle Scholar6. Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. "I wish I had seen this test result earlier!": dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004;164:2223-8. [PMID: 15534158] CrossrefMedlineGoogle Scholar7. O'Connor SD, Dalal AK, Sahni VA, Lacson R, Khorasani R. Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up? J Am Med Inform Assoc. 2016;23:333-8. [PMID: 26335982] doi:10.1093/jamia/ocv105 CrossrefMedlineGoogle Scholar8. Singh H, Arora HS, Vij MS, Rao R, Khan MM, Petersen LA. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459-66. [PMID: 17460135] CrossrefMedlineGoogle Scholar9. Murphy DR, Wu L, Thomas EJ, Forjuoh SN, Meyer AN, Singh H. Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial. J Clin Oncol. 2015;33:3560-7. [PMID: 26304875] doi:10.1200/JCO.2015.61.1301 CrossrefMedlineGoogle Scholar10. Pillemer F, Price RA, Paone S, Martich GD, Albert S, Haidari L, et al. Direct release of test results to patients increases patient engagement and utilization of care. PLoS One. 2016;11:e0154743. [PMID: 27337092] doi:10.1371/journal.pone.0154743 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Harvard Medical School, and Partners HealthCare, Boston, Massachusetts (G.Z., L.S., A.W.)Ariadne Labs at Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (F.L.M.)Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.A.)Presented in part at the American Medical Informatics Annual Symposium, Washington, DC, 7 November 2017.Note: Dr. Wright had complete access to the data and takes responsibility for the analysis.Acknowledgment: The authors thank David W. Bates, MD, MSc, who provided critical feedback on the manuscript.Financial Support: By the Partners-Siemens Research Council.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2425.Corresponding Author: Gianna Zuccotti, MD, Partners Healthcare System, Partners eCare, 399 Revolution Drive, Suite 1065, Somerville, MA 02145-1466; e-mail, [email protected]org.Current Author Addresses: Dr. Zuccotti: Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.Drs. Samal and Wright and Ms. Ai: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120.Ms. Maloney: Ariadne Labs, 401 Park Drive, Third Floor East, Boston, MA 02115.Author Contributions: Conception and design: G. Zuccotti, L. Samal, A. Wright.Analysis and interpretation of the data: G. Zuccotti, L. Samal, F.L. Maloney, A. Wright.Drafting of the article: G. Zuccotti, F.L. Maloney, A. Ai, A. Wright.Critical revision of the article for important intellectual content: G. Zuccotti, L. Samal, F.L. Maloney, A. Ai, A. Wright.Final approval of the article: G. Zuccotti, L. Samal, A. Ai, A. Wright.Statistical expertise: A. Wright.Obtaining of funding: G. Zuccotti.Administrative, technical, or logistic support: F.L. Maloney, A. Ai, A. Wright.Collection and assembly of data: G. Zuccotti, L. Samal, F.L. Maloney, A. Wright.This article was published at Annals.org on 17 April 2018. 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