No news is no news

“No news is good news.” If you hear that from your doctor, don’t take it at face value. A study (Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results) in today’s Archives of Internal Medicine reports that about one in fourteen cases of abnormal test results are not reported to patients. The authors found no significant difference between practices with and without electronic medical records. The worst performers were practices with a hybrid paper/electronic system. Some physicians closed the loop 100 percent of the time, some as little as 74 percent.

I’m not an Archives subscriber so I had to make do with reading press releases from the California Healthcare Foundation, JAMA (publisher of the Archives), and Weill Cornell Medical College. From the Cornell release:

“Failure to report abnormal test results can lead to serious, even lethal consequences for the patient,” says Dr. Casalino. “The good news is that physicians who use a simple set of systematic processes to deal with test results can greatly lessen their error rates.”

The study suggests that five simple, common-sense processes are useful for dealing with test results: (1) all test results are routed to the responsible physician; (2) the physician signs off on all results; (3) the practice informs patients of all results, normal and abnormal, at least in general terms; (4) the practice documents that the patient has been informed; and (5) patients are told to call after a certain time interval if they have not been notified.

The finding that EHR use makes no difference in the aggregate isn’t surprising, and points to the need for better systems and better implementation of the systems and adjustments to workflow. It also highlights the value of patient portals. For example, I get my care at Beth Israel Deaconess Medical Center in Boston and can log in to the PatientSite portal and easily look up my lab results. My doctor happens to be good at reporting my results, but if for some reason he slipped up or the results were delayed I could easily send him a note electronically and ask him what’s going on.

June 22, 2009

One thought on “No news is no news”

  1. I also get my care at BIDMC, but I can’t use patient site, because my doctor won’t participate in it. She is pretty good about making sure that someone gets back in touch with me and always tells me to get in touch with them if I don’t hear back within a certain time frame.

    As things are now, she is simply too busy to respond to e-mails. I wish that they were able to turn that feature off so that I’d be able to look at my lab results.

    (As an aside, I’ve also not been super impressed with the care I’ve gotten from nurse practitioners. I’ve had to go back every time I saw one.)

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