Over the past few months I have had several conversations with a former GE colleague who has had a storied history starting and managing several companies since leaving GE. Mark Schwartz of Healthcare Technology Consulting (www.htconsulting.net) has been involved in Critical Test Results Management (CTRM) for some time now, and is focused on raising the awareness of CTRM implementation.
Schwartz has a wealth of information on the market dynamics of CTRM. Citing a source from www.healthimaging.com, he emphasizes that 98,000 patients die each year due to medical errors, and that 75 percent of malpractice cases are communication related. He further references an American College of Radiology article that indicates that of malpractice cases citing test results, the most common problem is patients not receiving test results, and the second most common problem is the clinician didn’t receive the test results!
Schwartz cites that failed communication of test results can result in increased length of stay, delays in care, continuation of incorrect treatment, increased costs, regulatory issues, and greater risk of malpractice suits. The Journal of the American College of Radiology (JACR) examined medical malpractice claims from 425 hospitals and 52,000 providers, and found a rapid growth in diagnostic testing in the past decade put physicians at higher risk of malpractice claims for test communication failures, with malpractice payments up 40 percent!
According to Schwartz, a key objective on CTRM is satisfying Joint Commission National Patient Safety Goal #2, improving the effectiveness of communication among caregivers. Implementing CTRM can increase patient safety, ensure Joint Commission compliance, improve staff productivity, and guard against malpractice suits. CTRM systems accomplish this by getting results directly to the physician’s device securely, with an audit trail, so that the physician is able to take immediate action. CTRM systems can also alert and escalate the process if the physician does not respond.
In defining a good CTRM solution, Schwartz points out that it should be capable of interoperability with hospital information systems such as PACS and speech recognition systems, and it should allow the diagnostician to set the Acuity (severity) level. CTRM systems should be able to send alerts to a wide range of devices including smart phones, secure email, and pagers. Systems should also be able to manage audit trails for both senders and receivers, and should be able to present dashboards of alerts, including the average time to close the alert, as well as trends.
Key factors to consider in a CTRM system include the extensiveness of the feature set, standards compliance, a wide range of interoperability, and FDA approval. Another key consideration is enterprise support for environments spanning multiple facilities. Preparing for a CTRM should include an assessment of clinical workflow and an analysis of communications.
I have recently explored in this blog several aspects of advanced radiology (and other services) systems, including decision support and dose management systems. CTRM is yet another to consider. All these advancements point to the need to reassess the role of traditional systems such as Radiology Information Systems (RIS) and Picture Archive and Communications Systems (PACS), as their interoperability and roles continue to change. If traditional systems don’t offer these capabilities, it may be time for a change!