TEST RESULTS

From Critical to Incidental Findings

CRITICAL TEST RESULTS MANAGEMENT

Speeding care by sending critical test results to ordering physicians quickly

• Improve care

• Reduce wasted time

• Protect patient information

• Avoid litigation

HEALTHCARE MARKET DYNAMICS

Reducing litigation expense is a major driver for CTRM systems• Est. 98,000 U.S. patients die

each year due to medical errors, often communication errors

• “Of malpractices cases... 75% are communication related”

Source: www.healthimaging.com April 7, 2009. Critical test-result management systems help reduce malpractice suits.

THE COST OF POOR COMMUNICATIONS

“Brigham and Women’s Hospital spent between $35 and $40 million during a five-year period resolving lawsuits involving radiologists. Failure to communicate findings represented 20% of the lawsuits.”

– Vice Chair of Radiology at Brigham and Women’s Hospital

Source: www.auntminnie.com June 5, 2009. Critical results software – it’s cheaper than settling lawsuits

THE CHALLENGE: TIME TO DELIVER RESULTS

Results are critical - Sue’s physician must

be notified

Results entered into hospital’s results

system

• After some phone tag, Radiology speaks with Dr. Jones about Sue

• Dr. Jones recognizes the need for immediate treatment

• He must contact the appropriate physician for immediate action

Sue’s physician, Dr. Jones orders a radiological exam

Radiology techs attempt to contact Dr.

Jones

25 MINUTES TIME TO COMPLETE THE PROCESS:

START

SPEEDING RADIOLOGY RESULTS WITH SPOK

WITHOUT SPOK: 25 MINUTES TIME TO COMPLETE THE PROCESS:

START

WITH SPOK: 3 MINUTES

Results entered into Spok CTRM system

• Results sent directly to physician's device

• Message transmitted securely

• Includes audit trail

• Physician is able to take immediate action

• Spok system can message directly to Sue’s nurse on her wireless IP phone

• Request can be made to administer appropriate medication

Sue’s physician, Dr. Jones orders a radiological exam

EMR Sue Smith

Results are critical - Sue’s physician must

be notified

Radiologist selects and opens exam from PACS

worklist

Radiologist interprets image

and dictates exam report

Radiologist clicks on Spok CTRM

from PACS Menu Bar

Radiologist selects acuity level from

Spok CTRM pop-up window

Radiologist selects template

notification

Radiologist adds additional instruction

to notification and publishes the Critical

Finding

Radiologist closes exam and moves on

Spok sends notification to

Ordering Physician and other care team

members

Ordering Physician Accepts and calls back to consult with Radiologist

All activity saved in Spok

audit trail

CRITICAL RESULTS WORKFLOW - TRANSCRIPTION

Radiological exam is performed, and results are available via the PACS

.

RIS/PACS

Radiologist selects and opens exam from PACS

worklist

Radiologist interprets image and dictates exam report

into VR System

Radiologist initiates a Spok CTRM critical

finding by using voice command indicating

Acuity level

Radiologist closes exam and moves on

Spok CTRM automatically lifts the

impression with finding and acuity level from the

HL7 result message

Spok sends notification to

Ordering Physician and other care team

members

Ordering Physician Accepts and calls back to consult with Radiologist

All activity saved in Spok

audit trail

CRITICAL RESULTS WORKFLOW – VR SYSTEM INTEGRATION

Radiological exam is performed, and results are available via the PACS

.

RIS/PACS

THE CHALLENGE: READINGS DISCREPANCY

Radiological exam is performed, and results are available via the PACS

.

ED physician views results first, and makes a preliminary interpretation.

Notes are written on piece of paper.

Radiologist then reviews exam, and his diagnosis differs from the ED physician’s findings.

PACSRadiologist then needs to contact the ED physician to discuss discrepancy

.

Time Delay.

Radiologist reviews paper-based notes

ED physician makes preliminary read and enters notes in Spok

CTRM or EDIS (if integrated)

Radiologist selects and

opens exam from PACS worklist

Spok CTRM pops up with

preliminary read

Radiologist interprets image

and finds a discrepancy

Radiologist selects discrepancy

acuity level from Spok CTRM

Radiologist adds additional instruction

and publishes the Discrepancy

Radiologist dictates remainder

of report and moves on

Spok sends notification to ED physician only if

discrepancy found

ED Physician Accepts and

takes appropriate corrective action

All activity saved in Spok

audit trail

OVERCOMING READINGS DISCREPANCY

Radiological exam is performed, and results are available via the PACS

.

RIS/PACS

THE CHALLENGE: TIME TO DELIVER CRITICAL LAB RESULTS

• After some phone tag, Lab speaks with Dr. Jones about Sue

• Dr. Jones recognizes the need for immediate treatment

• He must contact the appropriate physician for immediate action

WITHOUT SPOK: 25 MINUTES TIME TO COMPLETE THE PROCESS:

START

Results entered into hospital’s results

system

Laboratory techs attempt to contact Dr.

Jones

Lab results are critical - ordering physician must be notified

.

Sue’s physician, Dr. Jones orders lab tests

SPEEDING CRITICAL LAB RESULTS WITH SPOK

• Results sent directly to physician's device

• Alert message is transmitted securely

• Physician is able to close the loop

• Alert will escalate in 15, 30, 60 min if the loop is not closed

• Escalation period can be configured by the hospital

• Results can be sent to multiple devices and multiple caregivers

WITHOUT SPOK: 30 MINUTES TIME TO COMPLETE THE PROCESS:

START

WITH SPOK: 3 MINUTES

Lab results are critical - ordering physician must be notified

.

Sue’s physician, Dr. Jones orders lab tests

EMR Audit Trail

Radiology / Cardiology / Pathology

AN ALERT CAN BE SENT TO: INFORMATION CAN INCLUDE:• Reports• Images• Annotations• Voice clips• Handwritten notes

ALERTS

Results entered into Spok CTRM system

CARE PROVIDER WEB ACCESS TO CTRM

Patient Care Team

Hospitalist

Techs

Nurses

ED Periop

ReferringPhysicians Specialist

s

`

RESULTS ONLY MATTER IF THEY’RE RECEIVED

Of test results specifically cited as a factor in a malpractice case:

• Most common problem: Patient didn’t receive test results

• Second-most-common problem: Clinician didn’t receive the results

Journal of the American College of Radiology, Volume 8, Issue 11 , Pages 776-779, November 2011

MEDICAL MALPRACTICE STUDY

Failure to Notify Reportable Test Results:

• Significance in Medical Malpractice

• Examined medical malpractice claims from 425 hospitals and 52,000 providers

Key Findings:

• Past Decade: Rapid growth of diagnostic testing puts physicians at greater risk for medical malpractice claims for test communication failures

• 1996 – 2003: Malpractice payments related to diagnosis 40%

REAL LIFE EXAMPLE — PEGGY KIDWELL3

• Mix-up over doctors’ names led to a year-long delay in a breast cancer diagnosis

• By the time it was discovered, her cancer had spread to her chest wall

• Kidwell filed a malpractice lawsuit and eventually settled the case

3Michelle Andrews. "Medical tests are pointless when results don’t reach the doctor or the patient.” The Washington Post National. Editor(s) of website. 28 Nov. 2011. Associated institution. 9 Mar 2012. <http:www.washingtonpost.com >.

INCONSISTENCIES ABOUND

According to a study in the January 2012 edition of Archives of Internal Medicine:• 69.3% of primary care physicians said they send specialists

notification of patients' histories all or most of the time

– Only 34.8% of specialists said they routinely receive such information

• Among specialists, 80.6% said they send consultation results to the referring physician all or most of the time

– Only 62.2% of primary care physicians reported ever receiving consultation results

CRITICAL TEST RESULTS MANAGEMENT

JOINT COMMISSIONNATIONAL PATIENT SAFETY GOAL #2Satisfies

Improve the effectiveness of communication among caregivers

MANAGE THE CTRM PROCESS

• CTRM Dashboard for PACS Admins and RADs

– View active notifications with status

• INSTANT AUDIT TRAIL

– Tracks all notifications through completion

– Export via HL7 to EMR to close the loop

• CTRM Analytics

– Sender/Receiver Activity Reports

– Average Time to Close Alerts

– Violations vs. Target Report

CASE STUDY:TUOMEY REGIONAL MEDICAL CENTER

• Improved patient care and sped treatment and discharge with faster communication of test results and incidental findings

• Reduced time physicians wasted calling around for test results or clarifications

• Developed a communications audit trail ready for Joint Commission visits“During the three months immediately following implementation, we saw an 11% improvement in patient discharge times.”

– José Bennett, PACS Administrator, Tuomey Healthcare System

ED physician listens to recording of Radiologist's findings, and

acknowledges having viewed the result on the Spok CTRM workstation.

Radiological exam is performed - Radiologist

speaks results into mic to initiate the results delivery

process.

Result appears in the ED workstation

Time saved in delivering the result, as Radiologist and ED physician do not have to play phone tag to speak and discuss findings

ED physician can view scan in PACS directly

from Spok CTRM workstation

CASE STUDY:TUOMEY REGIONAL MEDICAL CENTER

CASE STUDY:QUINTE HEALTH CARE

• Send test results from the Laboratory, Radiology, and Cardiopulmonary departments to ordering physicians

• Streamline communication of results to ER physicians

– Improve ER patient flow and minimize ER wait times

“We chose [Spok] because it’s not a cookie-cutter solution; we can tailor it to QHC. It works in all the diagnostic areas we report for —Cardiopulmonary, Radiology, and the Laboratory, and will provide efficiencies in the diagnostics and ER departments alike.”

– Dianna Kiss, PACS Coordinator, Quinte Health Care

Physician receives notification of the alert on their smartphone or pager -

can view alert and acknowledge from a PC

Radiologist uses dictation mic to record findings, indicate acuity level,

and initiate alerting process

Spok CTRM transfers closed alert info to Meditech EMR system

CASE STUDY:QUINTE HEALTH CARE

CASE STUDY:EMH HEALTHCARE

• Time savings and improved patient safety by alerting staff and posting results into the patient’s electronic medical record (EMR)

• Meets Joint Commission guidelines on communicating critical test results more efficiently“The ER doctors immediately see an alert on the EMR dashboard. As a result, communications are smoother and our ER process is now much less manual. We have also eliminated the need for radiology nurses to track reports and dictations, maintain a document log, and make calls to notify ER physicians.”

– Michelle Dossa, Manager, Department of Imaging Services, EMH Healthcare

Charge nurse carrying dedicated pager receives any escalations from Spok CTRM

system

Alert appears in the ED on the ED Information System (Siemens Syngo).

ED physician is able to view results and acknowledge

Radiologist initiates alerting process via Agfa PACS - opens

Spok CTRM app for Radiologist to select acuity

level.

Spok CTRM transfers closed alert info to Allscripts EMR system

CASE STUDY:EMH HEALTHCARE

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