An industry workgroup research group has concluded that despite the availability of HealthIT tools, many organizations don’t have a comprehensive, useful view of their diagnostic testing and specialty referral processes.
The group’s work focused on identifying gaps, failure points or breaks in their diagnostic testing and specialty referral processes, addressing these gaps, then using health IT tools to better track the results. The research was conducted by the Partnership for Health IT Patient Safety, which is part of the ECRI Institute.
To prepare for the analysis, the Partnership identified ambulatory care practices that were prepared to discuss technology solutions to their diagnostic issues.
One participant was a community-based provider with two locations specializing in family medicine. This site already had technology support in place through a vendor, and received IT recommendations through user groups, and had a user specialist in place, but still struggled with managing diagnostic testing referrals for CT, MRI and radiography services.
Another was an ambulatory care organization serving 75,000 patients at varied locations. The organization averaged 80,000 diagnostic testing and specialty referral requests per year. It got technology support from both internal staffers and a technology-controlled network allowing it to share common infrastructure with participating sites. IT leaders there were using process mapping and gap analysis to identify opportunities to improve tracking but were willing to step up their analysis further.
When looking at their challenges, the participating sites noted that referrals and imaging were the most difficult to follow and track due to language barriers, scheduling and insurances, and that tracking reports that existed weren’t really usable or actionable.
Reasons that diagnostic testing or specialty referrals weren’t getting completed included that the prior authorization process wasn’t completed, that the PA request was denied, that patients never got the PA to schedule or that the patients got the paperwork but didn’t schedule.
Other issues included that the diagnostic testing or specialty referral request wasn’t in the EHR despite being completed, the test/referral wasn’t tracked due to backlogs or the entry lacked data elements needed for follow-up. Other persistent problems included that testing and referral patients weren’t notified and that these processes weren’t being monitored or evaluated.
The net of all of this was that software and hardware functions capable of tracking these issues weren’t implemented or used as intended, clinical and electronic workflows weren’t aligned, these functions were hard to use, providers weren’t clear on the processes involved in such tracking. On top of all of that, often organizational policies, procedures and culture weren’t aligned with clinical and electronic workflows. In other words, the providers were looking at a cumbersome, convoluted mess.
Once members figured out what the key problems with these processes were, the workgroup developed a list of steps providers could take to manage these processes more effectively. The list included:
- Making sure providers and staff use the EHR to track such issues rather than inventing workarounds.
- Insisting the clinicians and staff use existing technology, rather than circumventing automated systems designed to track orders by relying on, say, paper-based tracking.
- Working with the EHR vendor to automate as many testing/referral functions as possible, along with having them create functionality flagging tracking problems that could create risks. Examples include when diagnostic tests or referrals aren’t referred or never get viewed by the provider.
- Developing EHR-based custom reports which can help practices keep an eye on their performance in these areas.
In closing, the report noted that patients were also struggling with closing these loops, and that it would be good to help them work through these complexities as well. After all, gap analyses and the like mean little if the patient doesn’t get tested or referred and ends up being harmed.
That being said, providers need to do a lot better at tracking testing and specialty referrals – and if clinicians and staff actually use them, health IT can help to make it happen. (By the way, if workarounds are an issue that interests you, check out this fabulous piece from John Lynn on how health IT leaders creatively, let’s say, bypass enterprise IT problems.)