1. Diagnostic QI Repository
  2. SIDM-IHI Learning Collaborative

Tufts Medical Center

About the Tufts Medical Center Pilot Site Project

Project Leads: Saul N. Weingart, MD, PhD, William Harvey, MD, Omar Yaghi, MD, MPH  

Radiology orders that are not completed, or completed and not followed up increase the risk of diagnostic errors. The Outpatient Radiology Results Notification Engine (“Results Engine”) is designed to send notifications related to outpatient orders/results to Tufts MC Physicians who place these orders. The workflow starts when a Radiology order is placed for a patient and an appointment is scheduled. If the appointment date is less than five days from the date the appointment was scheduled, or if the order is for an inpatient admission, then the Results Engine will not track that order because it is assumed to be at low risk of missed follow up.

Otherwise, the Results Engine sets a timer to expire 14 days from the time/date of the outpatient test appointment. The Results Engine began generating automated email alerts in April 2016 starting with Rheumatology and was expanded to pulmonary and adult primary care outpatient clinics. The Results Engine capability can help clinicians ensure that planned follow-up testing is completed and followed up for abnormal pap smears, lung nodules, skin biopsies, colon polyps, and mammograms. It can also be used to alert clinicians about delayed and canceled high-risk referrals (e.g. surgical evaluation for breast nodule or gastroenterologist for rectal bleeding).

The project is well aligned with efforts to improve diagnostic error and malpractice liability associated with ambulatory care. Already, participating clinicians have identified several occasions where an important missed imaging test was detected using the Results Engine and led to successful completion of the test. Our initiative is a potentially generalizable approach for identifying missed and delayed test results, even in health systems employing multiple different EMRs. Email notifications are sent securely within the medical center firewall. Like many projects, implementation is more complicated than one might imagine, even if the original plan was to disseminate an established tool. Future work should address methods to accelerate and test the deployment of this approach, to examine its impact on busy providers, and to prevent serious diagnostic delays. The Results Engine makes the invisible (missed visit) visible.