– Interventions to minimize health IT outpatient diagnostic delays at major health systems could improve interoperability, information overload, test result management, order entry, and data visualization, according to a national root cause analysis, published in JAMA Network Open.
Diagnostic delays are a major threat to outpatient safety. Health IT aims to reduce diagnostic delays by tracking test results, improving information access, facilitating communication between clinicians, and supporting test selection.
“For instance, inadequate test result follow-up is a substantial cause of diagnostic delays in EHR-enabled settings,” wrote the study authors. “Although electronic test result transmission is more reliable than one on paper, action on test results may be delayed.”
“More than one-third of patients with lung cancer experience diagnostic delays, mostly from delayed follow-up of abnormal imaging findings. Similar follow-up failures can occur in bladder, gastrointestinal, and breast cancer diagnosis.”
Addressing diagnostic delays in the context of health IT requires a high level of understanding complex systems that accounts for interactions between health IT, its users, policies, and workflows.
“In this study, we used the analytic lens of the Health IT Safety framework to generate a better understanding of diagnostic delays in the setting of HIT,” the authors explained.
“The Health IT Safety framework provides a conceptual foundation for measuring, monitoring, and improving HIT safety and includes 3 related domains situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety.”
The three domains include: safe health IT, safe use of health IT, and using health IT to improve safety.
Researchers utilized the Health IT Safety framework of aggregated root cause analyses (RCAs) to dissect all safety concerns in RCA data related health IT at the US Department of Veterans Affairs (VA) health system between 2013 and 2018, and analyze the role of health IT safety for possible solutions.
Throughout that five-year time period, over 200 RCAs were categorized and submitted by either “delay” or “outpatient” complaints. Of those 214 complaints, 172 fell under unique health IT-related safety concerns and 88 involved diagnostic delays.
Eighty-two percent of safety concerns were connected to the safe use of health IT. These factors were mostly based on workflow and communication with people, and poorly-designed EHRs.
On the other hand, only 14.5 percent of concerns were related to safe health IT and 0.3 percent targeted health IT to improve safety.
Researchers found five consistent responses that led to diagnostic delays: technical issues, data entry problems, EHR inbox notifications, gathering diagnostic information, and a lack of tracking test results.
The majority of these issues were tied to sociotechnical problems, such as a lack of health IT and EHR training, miscommunication, inadequate coverage, and EHR design.
On the contrary, safe health IT issues primarily focused on EHRs and hardware, even though there are implemented tracking systems to improve safety.
The researchers utilized Health IT Safety framework to identify the root cause of outpatient diagnostic delays in large health systems.
“These aggregated RCA data provide evidence that high-yield interventions could be aimed at improving test result management, interoperability, data visualization, and order entry, as well as reducing information overload and overreliance on electronic documentation for communicating critical information,” concluded the authors.
“The complexity of the association between HIT and diagnostic delays described herein underscores the need for collaboration between clinicians, health system leaders, safety professionals, and HIT designers in the testing and implementation of interventions to improve outpatient safety.”
To potentially help matters, the VA is in the midst of implementing a new EHR system, the Electronic Health Record Modernization (EHRM) program. However, the implementation process is in the middle of its third delay since November 2019, this time due to the spread of the coronavirus.