WASHINGTONOne way to ensure that the right parties receive
imaging study results and actually look at them is to make
notification nearly fail-safe. A system in use at the Veterans
Administration Medical Center, Asheville, NC, as well as other VAs,
does exactly that, David M. Schuster, MD, staff radiologist at the
hospital, said at the 100th annual meeting of the American Roentgen
The system has zero tolerance for missed results, he
said, and it significantly reduces delays in diagnosis.
Ideally, when a clinician orders an x-ray or other imaging study, the
results are transmitted quickly, the clinician looks them up as soon
as they come in, and then just as quickly notifies the patient. But
in a busy hospital setting, this doesnt always happen, Dr.
Schuster said. Delays can occur at each step of the way.
In the VA medical network, every clinician must be registered in the
computer system, he said. Regular communication is sent by e-mail,
but when an imaging study is ordered, the request is transmitted by a
separate computerized route bearing the clinicians electronic signature.
When an imaging study is completed, a staffer types the results into
the computerized system. The radiologist verifies the report and
signs it electronicallyat which point the system asks that a
code signifying severity be assigned. If you try to skip over
this part, itll just take you right back to it, Dr.
Once the code is assigned, the report is then automatically sent to
the ordering clinician. Abnormalities, which include codes for
malignancy or possible malignancy, and infection, fracture, and other
noncancerous conditionstrigger an alert that appears regularly
on the clinicians screen.
For abnormalities requiring quick actionpneumothorax, for
examplethe radiologist will call the clinician, Dr. Schuster
said, in addition to filing the computerized results.
The system is structured so that if the ordering clinician does not
call up the report within 2 weeks, the computer sends it
automatically to the clinicians supervisor. If the supervisor
doesnt read it, it can be forwarded to the hospitals
quality management (QM) team.
In Asheville, the quality management team monitors how well the
hospital is doing with code 2 alertscodes that
notify clinicians of a patients malignancy or possible
malignancy. The team checks on which alerts have been acted upon and
which have not.
About 6 months ago, before the system went fully into
operation, the QM people said about half of the No. 2s had not been
acted upon 2 weeks to a month later, Dr. Schuster said. By
February 2000, that figure had dropped to 10%.
Why is there any delay at all? Dr. Schuster said that a physician
might wait until a patients next appointment to deliver test
results. QM would call to nudge the clinician. Now, the nudge
is more often delivered by computer, he said.
The system has not required extra hardware to get up and running, Dr.
Schuster said. It was set up using information architecture present
at every VA hospital (Veterans Health Information System and
Technology Architecture). It uses Compaq PCs and the Virtual Memory
System operating system with applications written in the
Massachusetts General Hospital Utility Multi-Programming System