Electronic Medical Alerts Don't Guarantee Timely Response
Electronic medical alerts are a significant improvement over paper-based systems, but doctors often still ignore warnings they should pay attention to, according to a recent study. Even when notified electronically, doctors sometimes ignore test results that show the patient might have a serious problem.
Electronic medical alerts are a significant improvement over paper-based systems, but doctors often still ignore warnings they should pay attention to, according to a recent study. Even when notified electronically, doctors sometimes ignore test results that show the patient might have a serious problem.The study, conducted at the Michael E. DeBakey Veterans Affairs Medical Center and its clinics, found that doctors didn't follow up within a month on nearly 8% of serious alerts, involving abnormal results, some later diagnosed as cancer, on imaging tests such as MRIs and X-rays.
"This shows we still have a lot of work to do," said Dr. Hardeep Singh, a Baylor College of Medicine professor and VA administrator who led the study. "It also shows you can't just install an electronic system and assume it'll work optimally. There's a human factor."
The study, published Monday in the Archives of Internal Medicine, nonetheless showed an improvement over paper-based systems, in which records are mailed or faxed, said Singh. In a 2004 Harvard study in which paper-based systems were used, 64 percent of women whose mammograms showed abnormal results received timely follow-up.
To determine how well it was working, Singh looked at 1,196 abnormal test results between November 2007 and June 2008 that generated alerts to the VA clinician who ordered them. Timely follow-up with patients did not occur following 92 of alerts, including 7.3 percent that were read and acknowledged by the doctor and 9.7 percent that weren't.
Grimly, the 92 overlooked alerts showed potential aneurysms, cancers, and spinal cord problems. In nearly all the cases that lacked timely follow-up, the conditions got worse.
Sometimes, a good study simply confirms common sense. This is one of those times. We've all had the experience of sending important mail to colleagues, superiors, or subordinates, only to have that e-mail ignored.
The study also confirmed a couple of other points that e-mail power-users already know: Sending e-mail to multiple people made the follow-up even less likely to occur, maybe because each person thinks the other recipient or recipients would take care of it.
And e-mail is most effective when followed up with a phone call, or some other verbal reminder: "Follow-up was more likely to occur when a radiologist also communicated concerns about the result verbally."
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