Electronic Medical Records May Not End Lapses

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Critical results from medical imaging tests such as MRIs and X-rays, even when sent by electronic e-mail alerts to doctors, may “fall through the cracks” without prompt attention and follow-up, a review of U.S. veterans’ medical records found.

About 18 percent of the 1,196 outpatient imaging results that generated electronic alerts showing medical abnormalities were not read or acknowledged by doctors at a Department of Veterans Affairs hospital in Houston and its clinics, the survey found. Researchers found 7.7 percent of the alerts, including some diagnosed later as cancer, weren’t followed up by physicians within a month of receiving them, according to a study published today in the Archives of Internal Medicine.

Electronic medical records, which are computerized to allow doctors easy access to a person’s health information, enabled researchers to track how well doctors respond to test results that required action, said lead author Hardeep Singh. Finding and fixing problems at Veterans Affairs hospitals, where records already are electronic, will help other doctors and health systems as they move from paper records toward similar information technology systems, he said.

“As we monitor these things we’re going to find them and fix them,” said Singh, a doctor and researcher at the Michael E. DeBakey VA Medical Center in Houston, in a Sept. 25 telephone interview. “We’re going to pave the way for the rest of health care.”

Health experts have touted the use of electronic medical records as a way to improve medical care and reduce costs in the U.S. Congress agreed in February to spend $19 billion to improve information technology as part of the stimulus program. The Obama administration last month announced $1.2 billion in grants to help doctors and other providers convert to computerized medical records.

Initial Optimism

At the start of the study, the researchers assumed that a system with electronic medical records and alerts would be better than paper records at minimizing the chance doctors would overlook important test results, according to the journal article.

Researchers led by Singh found that even with e-mail alerts, some test results were ignored.

"Even in the best of information systems that contain advanced notification features, patients with abnormal imaging test results are vulnerable to ‘falling through the cracks,'" Singh wrote in the journal article.

Electronic Alerts

The study looked at electronic alerts about outpatient imaging test results sent to doctors from November 2007 to June 2008 at the DeBakey VA Medical Center and five of its clinics. The researchers used software to determine if alerts contained abnormal test results and whether those results were read within two weeks. They then looked at the patient's medical records and contacted their doctors to see if follow-up actions were taken within four weeks of the alert.

Of the 123,638 imaging tests -- including X-rays, computer tomographic or CT scans, magnetic resonance imaging and mammograms -- about 1 percent or 1,196 generated alerts. Of those, 217, or 18 percent, were not read or acknowledged, the researchers found.

Among those 1,196 alerts, timely follow-up of the abnormal results didn't occur in 92, or 7.7 percent. Of the 92 results, 26 led to a new diagnosis, including 11 that were determined to be cancer, the study said.

Communications Mixup

Singh said some of the alerts may not have been read because the radiologist called the doctor with the same results. Physicians also may be overloaded with e-mails, unsure who is responsible for follow-up care when more than one doctor is treating the patient or has time management issues. The information may also not be presented clearly, he said.

"The large majority of these things are getting follow up," he said.

Singh said patients need to take charge of their own health care and call doctors if they haven't heard back about the results of a test.

"No news is not necessarily good news from the doctor," he said. "We need patients to be a little more empowered."

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net.

Source: Bloomberg News

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