New Research Offers Key Insights on Health IT Diagnostic Delays
July 6th, 2020
A new study finds the root causes of health IT diagnostic delays. Learn about the causes and possible interventions to reduce them in this post.
Health IT diagnostic delays are a problem. They stand as a real and urgent threat to patient care. The aim of healthcare IT is to reduce delays through a variety of tasks. They seek to track test results, enable information access, encourage communication between clinicians, and support test selection.
Those are the goals. Achieving them isn’t so easy. To determine the root causes of failures, a new JAMA published research report looked at data from the Department of Veteran Affairs from 2013 to 2018.
Researchers choose this data set to identify the root cause of outpatient diagnostic delays. In determining these, specific IT interventions can be put in place to minimize delays.
About the Study
Knowledge of system interactions is necessary to analyze the delays. These interactions include health IT, users, workflows, and policies. To get to this level of analysis, the authors used the Health IT Safety framework. This framework includes concepts for measuring, monitoring, and improving HIT safety. It has three interrelated domains: safe health IT, safe use of health IT, and using health IT to improve safety.
Further, researchers applied the framework’s aggregated root cause analyses (RCA) to identify and understand safety concerns in the data.
The research categorized 214 RCAs. Most safety concerns belong to the safe use of healthcare IT (82.6%).
The other domains had little correlation—only 14.5% dealt with safe healthcare IT and .3% attributable to using healthcare IT to improve safety.
The Five Most Common Health IT Diagnostic Delays
Looking further into the use of healthcare IT, the authors pinpointed six root causes.
The biggest technical issues concern failure to generate notifications. In some cases, set-up of alerts never occurred, while in others, a physician changed the settings. No alerts, no follow up.
Second, incorrect radiology codes were the culprit. If the codes are no longer viable, there will be no triggers for notification.
In some situations, the notification disappeared after opening. If it’s no longer there, clinicians were more likely to miss it.
Equipment not working also drove failures. For example, a malfunctioning printer didn’t print test notification letters. Without protocols to check equipment, this can balloon to a huge problem.
Two more concerns exist for this problem. Hidden dependencies impact information flows. The final issue deals with software upgrades. After upgrades, functionality may change. If no one is monitoring this, it increases lags in notifications.
Data Entry Problems
Data entry is an integral part of patient records. It’s also prone to human error. If information is missing, order entries may not transmit. Compromise of order entries can also occur because prioritization fields aren’t available or outdated test lists.
Missing documents is also a data entry problem. Either clinic notes were missing altogether or, due to user interface issues, were not in the right place.
EHR Inbox Notifications
Primary care practitioners (PCPs) receive these when test results are available. However, the notifications can be excessive, leading to missing important information. According to an information overload study and a practitioner’s views on test results in EHRs, one-third of PCPs miss abnormal test results.
Clinicians could receive up to 100 notifications a day! In addition to notification fatigue, failures happened when there was no coverage for a physician not in the office.
An additional concern is that new users don’t know how to process these notifications due to little or inadequate training. Finally, notifications suffer from ambiguous follow-up roles. In many cases, more than one clinician has involvement in the testing process. However, without a clear protocol on follow-up, many times, nothing happens.
Delayed Communication or Miscommunication
Clinicians use EHRs to communicate time-sensitive and critical patient information. This channel doesn’t always work. This problem usually occurs in how systems use the notes section. Not having consistent communication causes delays.
Miscommunication arises when clinicians use the wrong tools. For example, patient triage symptoms should appear in the triage tool, not a scheduling tool.
Gathering Diagnostic Information
Gathering information is a root cause, mostly due to healthcare interoperability challenges. Attribution of the delays in the specific study involved internal and external data sources. Being able to aggregate from multiple sources was met with significant challenges.
The authors found that relevant information was often not visible because it was in pages of scanned documents. The information belonged in a problem list.
The third problem in this category relates to patients seen without a review of abnormal test results. Without it, no one addressed the tests.
These breakdowns occur because of poor EHR UX, as well as issues with workflow and communication.
Not Tracking Test Results
If the system doesn’t track test results, there will be a host of problems. In the study, there were instances of no tracking and broken tracking. Tracking is necessary for patient safety and timely response to abnormal tests. There’s no time for delay in tests that show cancer, infections, or other aggressive diseases.
Why Do the Failures in these Areas?
The authors deduced that these delay causals were people, workflows and communication, and poor UX for users in the system. Users often have minimal training on EHRs, a constant struggle and key reason for EHR dissatisfaction.
How Can Healthcare IT Intervene?
The authors recommend five interventions to address health IT diagnostic delays.
- Redesign the EHR inbox and message workflow: Restructure the inbox for better prioritization, display, and filtering.
- Develop safety nets to catch missed test results: Technological tools help ensure nothing goes without a response. These safety nets may already exist in some EHRs, or a custom data plug-in may work. Power the plug-in with algorithms to hunt for unanswered results.
- Improve diagnostic information visibility: EHRs should take this under advisement. Interfaces should make this information prominent instead of hidden.
- Track referrals: Healthcare organizations need tracking systems for all electronic referrals so that patients don’t fall through the cracks.
- Optimize order entry design: To achieve this, EHRs should provide decision support and auto-population with required data. This reduces the reliance on manual entry.
- Accelerate interoperability: When systems can’t exchange data, limitations, and delays will continue. The new interoperability rule seeks to provide this; however, interoperability is not a smooth journey.
Healthcare Data Management Solutions
If these challenges sound familiar, then it’s time to work on how to minimize these delays. Streamlining workflows, adding new functionality, and pursuing interoperability will be imperative. Your IT team may not have the bandwidth to manage all these needs.