Follow-up flubs: Electronic tracking may help manage patient care

A recent study from the University of Pennsylvania (UPenn) found one-in-eight patients at the institution with imaging findings of possible cancer did not receive necessary follow-up care within three months of the finding, signaling the need for better electronic tracking and automatic notification of results.

Caroline E. Sloan, of UPenn's Perelman School of Medicine, and colleagues' work was published in the December issue of Academic Radiology.

The authors noted that automated systems can decrease provider notification time for abnormal results and increase completed follow up procedures.

“However, the effect of these systems in radiology remains relatively unexplored compared to other areas of medicine," the authors wrote. “In addition, optimal methods for communicating nonemergent radiology findings to physicians are poorly understood.”

To better understand the reasons that lead to lack of follow-up care, Sloan and team identified all abdominal imaging examinations with findings of possible cancer performed on six random days from August to December 2013. Medical records of one patient group were reviewed three months later to determine whether patient care management in light of the potential abnormal finding was appropriate. Providers of a second group of patients were contacted five to six days after imaging exams to determine notification preferences.

Of 606 patients evaluated on the six random days, 71 (12 percent) had at least one imaging finding of possible cancer in the liver, pancreas, kidney or adrenal gland. A total of 79 findings of possible cancer were contained in these exams.

The majority (66 percent) of these imaging examinations were performed with CT—the proportion of findings that were suspicious for malignancy were greater with CT and MRI scans (62 percent and 76 percent respectively) than with ultrasound examination (14 percent).

Of the 48 patients with a known history of cancer, 81 percent had active cancer.

Further study found that 74 percent of patients had documentation of planned follow up in the medical record, including imaging, change or continuation of chemotherapy, biopsy or surgery and referral to specialist.

Three months after initial detection, 84 percent of patients had completed follow up and 16 percent had not. Eleven patients (26 percent) did not have any follow up ordered within three months of their index radiology examinations.

The team found that 12 percent of patients with imaging findings of possible cancer received potentially inappropriate management three months after initial detection.

Also, one third of providers were unaware of imaging findings of possible cancer nearly a week after detection. Additionally, most providers preferred to be notified of imaging findings of possible cancer via an e-mail or a message containing an embedded hyperlink enabling immediate follow-up order entry.

Only 25 percent of providers questioned by Sloan and colleagues had a system to monitor whether their patients had completed ordered testing in the authors' health system.

“This pilot study sheds light on follow-up patterns and provider communication preferences for imaging findings of possible cancer in four ways,” the authors wrote.

A potential remedy for the mismanagement of findings could lie in tracking technology.

“Electronic tracking of these imaging findings could address some of the reasons for lack of follow-up found in our study, such as failure to receive results or generate a follow-up plan, but will not address other reasons, such as failure to communicate inpatient imaging findings to outpatient providers outside the health system,” Sloan and colleagues wrote.