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Electronic Medical Alerts Often Ignored to Patients Peril


There is a great push for electronic medical records (EMRs) as part of the health care reform efforts. Advantages cited are increased efficiency and a higher quality of health care. Many assume EMRs will decrease errors, missed tests results, improve timely follow-up on abnormal test results, etc. A new study published yesterday in the Archives of Internal Medicine was conducted to look at whether those assumptions EMRs and electronic medical alerts are true. The study was done at the Michael E. DeBakey Veterans Affairs Medical Center and its clinics.

The EMR used by the Department of Veterans Affairs (VA) relies on a notification system (the "View Alert" window) to alert clinicians about critical test results. These electronic medical alerts involve abnormal results on imaging tests such as MRIs and X-rays. The study found doctors failed to follow up on nearly 8 percent of such electronic alerts within a month of the alert.

The researchers gathered data by identified all electronic medical alerts for critically abnormal radiographs, computerized tomographic (CT) scans, magnetic resonance images (MRIs), mammograms, and ultrasonograms transmitted electronically in the multispecialty ambulatory clinic of the Michael E. DeBakey VA Medical Center (MEDVAMC) and its 5 satellite clinics from November 2007 to June 2008.

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The researchers identified 1,196 abnormal test results that generated medical alerts to the VA clinician who ordered them. Using the Alert Tracking File in the EMR, the researchers were able to confirm that doctors actually received the alert. Timely follow-up with patients did not occur following 92 of electronic medical alerts, including 7.3% that were read and acknowledged by the doctor and 9.7% that weren't.

The follow-up was even less likely to occur when more than one clinician received the electronic medical alert. When a radiologist communicated concerns verbally about the abnormal results, follow-up was much more likely to occur. The 92 alerts showed potential aneurysms, cancers and spinal cord problems. In nearly all lacking timely follow-up, the conditions got worse.

“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.”

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(17):1578-1586; Hardeep Singh, MD, MPH; Eric J. Thomas, MD, MPH; Shrinidi Mani, BA; Dean Sittig, PhD; Harvinder Arora, MD, MPH; Donna Espadas, BS; Myrna M. Khan, PhD, MBA; Laura A. Petersen, MD, MPH