Cleveland Clinic

Improving the Follow-up and Resolution of Actionable Imaging Findings by Actively Engaging Patients & Providers 

Project Lead: Rekha Mody, M.D. 

Project AIM(s)

  • Create initial notification MyChart messages and standard letters to notify patients of an actionable imaging finding in their imaging report  
  • Schedule recommended ordered imaging exam by imaging navigators to improve likelihood that patient will complete the recommended imaging exam 
  • Create provider level Tableau dashboards to improve provider accountability for ordering recommended imaging test or resolving findings  
  • Create terminal reminder letter to inform patients of aging/overdue actionable results 
  • Utilize Customer Relationship Management System Software (CRM) to remind patients they have an open actionable result on an imaging exam or need to schedule an exam  

Narrative Description

The current actionable results program has numerous alerts to the providers within MyChart indicating there is an important finding in an imaging report that may need follow-up. However, other than the imaging report that is released to the patient at the time of report read, the patient is not further informed of this important finding unless the provider reaches out. The initial notification letter is meant to further entrust the patient with their health-care information. When the patient receives this information, they will be prompted to contact their provider to get more information or obtain a provider within the system if they do not have one. Once the provider places the appropriate order, the imaging support services navigators will reach out to help schedule the exam. Ordering providers will also be sent an email monthly to maximize the possibility that they will resolve the actionable imaging finding; eventually, we hope to make this a part of a physician annual review with a goal of 100% resolution of open actionable findings. In addition, patients with persistent overdue actionable results will be informed when an actionable result is >=90 days overdue via a final letter. Finally, we will use a system of MyChart messages and text messages to remind them of open actionable results with instructions on how to address the actionable finding. With these interventions, we hope that we will diagnose more early stage cancers and save lives.

The majority of the project period was spent creating the intervention processes, but measurements were obtained for recommended ordered imaging exam scheduled by imaging navigators. By the end of the project period, 40% total open orders were successfully scheduled with up 95% success rate in scheduling imaging exams. During the course of the project period the team experienced multiple time consuming and technical challenges associated with initial discovery for patient MyChart messaging and creating Tableau dashboards. Other challenges included numerous rounds of review by various stakeholders, individual provide buy-in, and other IT projects being prioritized.

Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention

  • Patient delayed or unable to access to care
  • Information gathering
  • Information integration
  • Information interpretation
  • Establishing an explanation (diagnosis)

Root causes/causative factors addressed by the intervention

  • Patient-clinician interaction (includes patient and family engagement)
  • Workflow (includes testing, follow-up, and referrals)
  • Health information sharing and accessibility via health IT
  • Knowledge gaps/inexperience

Setting of the diagnostic quality improvement intervention

  • Ambulatory medical care setting (e.g., clinic, office, urgent care)