Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results

Murphy, Daniel R.; Meyer, Ashley N. D.; Bhise, Viraj; Russo, Elise; Sittig, Dean F.; Li, Wei; Wu, Lindsey; Singh, Hardeep

doi:10.1016/j.chest.2016.05.001

Cited by 34 publications

(26 citation statements)

References 43 publications

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“…As with prior work on this topic [30,[32][33][34], we found many instances of delays where no documented plan for subsequent follow-up was detected. This suggests that providers could be missing urinalysis results that return with hematuria, even when the red blood cell count is at a high enough level to warrant additional diagnostic evaluation for cancer.…”

Section: Commentsupporting

confidence: 74%

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Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Murphy¹,

Meyer²,

Vaghani³

et al. 2017

Appl Clin Inform

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Section: Commentsupporting

confidence: 74%

“…We previously evaluated triggers to identify delays in colorectal, lung, and prostate cancer and achieved predictive values useful in clinical practice [30,[32][33][34]. In this study, we expand on this work by developing and testing a trigger algorithm to detect delays in diagnostic evaluation of a urinalysis result with hematuria.…”

Section: Introductionmentioning

confidence: 99%

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Murphy¹,

Meyer²,

Vaghani³

et al. 2017

Appl Clin Inform

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“…Third, we were similarly unable to have a second reviewer review a subset of records to confirm delays. However, inter-rater reliability for our chart review studies identifying similar types of delays has been quite high (kappas typically > 0.80), 24,35 adding confidence to our findings. Finally, data on clinical outcomes were not included or analyzed, limiting our ability to understand the clinical impact of care delays in these cases.…”

Section: Discussionsupporting

confidence: 64%

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

et al. 2017

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BACKGROUND: Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. OBJECTIVE: To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. DESIGN: We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. KEY RESULTS: During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). CONCLUSIONS: An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

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“…Results from the National Lung Screening Trial demonstrate that early recognition and intervention of lung cancer improves survival [13]. Institutions across the country have approached this problem by developing interventions to reduce the loss-to-follow-up rates, with varying degrees of success [3,4,[14][15][16][17]. With the expansion of the electronic health record (EHR), there are new tools to reduce the frequency of failed follow-up and potentially save lives [17].…”

Section: Introductionmentioning

confidence: 99%

Effect of an Automated Tracking Registry on the Rate of Tracking Failure in Incidental Pulmonary Nodules

Shelver

Wendt

McClure

et al. 2017

Journal of the American College of Radiology

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Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results

Abstract: Application of triggers on "big" EHR data may aid in identifying patients experiencing delays in diagnostic evaluation of chest imaging results suspicious for malignancy.

Cited by 34 publications

References 43 publications

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism

Effect of an Automated Tracking Registry on the Rate of Tracking Failure in Incidental Pulmonary Nodules

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