Improving Diagnostic Process Safety
Ronilda Lacson, M.D., Ph.D.
Brigham and Women’s Hospital
Harvard Medical School
“AHRQ funding has enabled me to apply my background in informatics and information technology to enhance and address problems with the diagnostic process, improving patient safety.”
Medical test results help to guide patient treatment. But critical results are not always communicated or acted upon in a timely way, which can result in delayed diagnoses and patient harm.
Ronilda Lacson, M.D., Ph.D., associate professor of radiology at Harvard Medical School in Boston, has dedicated her career over the past decade to researching diagnostic safety, including factors that contribute to poor outcomes, such as untimely communication of test results and missed follow-up. With funding from AHRQ, Dr. Lacson and colleagues developed and promoted adoption of an electronic alert notification system that automates communication and management of test results across care settings. Further, she has helped researchers better understand how human factors – elements that impact an individual’s performance – can help to make tasks, such as scheduling exams and follow-up, more efficient, effective, and safe.
Dr. Lacson, who is also a research scientist at Brigham and Women’s Hospital Center for Evidence-Based Imaging, received partial funding from AHRQ in 2010 to implement and evaluate an automated notification system to improve communication of diagnostic imaging results. The information technology (IT) system, which alerts referring physicians when critical imaging results are identified, automates communication of results in a non-interruptive manner. The system also ensures that physicians document acknowledgement in a closed-loop system – one that confirms and cross-checks the sending and receipt of information. Conducted at a 753-bed academic medical center, the research showed a ninefold increase in critical results communicated via the system. This project was significant, since it helped pave the way for today’s more widespread use of these systems for diagnostic imaging, including adoption of the test result communication system design by commercial IT vendors.
Following her research to improve communication systems, Dr. Lacson expanded her focus to improve follow-up on test results for critical, but non-acute findings, such as liver lesions or lung nodules. "While these types of findings may be indolent, follow-up testing after 6 months or a year may be critical, because a substantial portion of these lesions turn out to be cancer," said Dr. Lacson. She added that “Non-urgent follow-up is appropriate for these types of lesions, but are so distant that they fall through the cracks in the system, with potentially disastrous consequences.”
Seeking to address this issue, Dr. Lacson received AHRQ funding in 2014 to study interventions to improve follow-up on critical test results during transitions from the hospital to an ambulatory setting, as transitions can exacerbate failures in follow-up. Through the study, Dr. Lacson and her team monitored critical imaging results for pulmonary nodules that required follow-up testing, and then communicated those recommendations to primary caregivers through the hospital discharge module. The study found that use of the discharge module increased follow-up from 18 to 27 percent within 1 year after discharge from the hospital. While Dr. Lacson considers this an improvement, she noted that, "A significant gap persists, and we are a long way from 100 percent."
To help reach that goal, Dr. Lacson is working on an AHRQ-funded project to study human factors, encompassing the complex interplay of staff and patient behaviors along with poorly designed tools, environment, and organizational factors that can lead to inappropriate exams and suboptimal follow-up. The project, which ends in May 2021, includes a comprehensive study of follow-up care for patients with suspicious findings on breast imaging examinations and lung nodules on chest computerized tomography scans in ambulatory care settings. Preliminary findings suggest that it is not enough to implement IT systems that prompt follow-up on test results; health systems must also consider a range of human factors, such as transitions in care and patient concerns about scheduling of testing that include but are not limited to location, care coordination, and insurance coverage/co-payment that can impact diagnostic process safety.
Dr. Lacson was elected to the Academy for Radiology and Biomedical Imaging Research’s Council of Distinguished Investigators in 2020. She is also a member of the American College of Physicians, American Medical Informatics Association, Radiological Society of North America, and Society to Improve Diagnosis in Medicine.
Principal Investigator: Ronilda Lacson, M.D., Ph.D.
Institution: Brigham and Women’s Hospital, Harvard Medical School
Grantee Since: 2010
Type of Grant: Various
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