title: Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication.
abstract: BACKGROUND
  Early detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response.
  
  
  METHODS
  Using both qualitative and quantitative methods, we evaluated positive FOBT communication in the electronic health record of a large, urban facility between May 2008 and March 2009. We identified the source of test result communication breakdown, and developed an intervention to fix the problem. Explicit medical record reviews measured timely follow-up (defined as response within 30 days of positive FOBT) pre- and post-intervention.
  
  
  RESULTS
  Data from 11 interviews and tracking information from 490 FOBT alerts revealed that the software intended to alert primary care practitioners (PCPs) of positive FOBT results was not configured correctly and over a third of positive FOBTs were not transmitted to PCPs. Upon correction of the technical problem, lack of timely follow-up decreased immediately from 29.9% to 5.4% (p<0.01) and was sustained at month 4 following the intervention.
  
  
  CONCLUSIONS
  Electronic communication of positive FOBT results should be monitored to avoid limiting colorectal cancer screening benefits. Robust quality assurance and oversight systems are needed to achieve this. Our methods may be useful for others seeking to improve follow-up of FOBTs in their systems.
authors.affiliation: The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, VA Medical Center (152) 2002 Holcombe Blvd, Houston, TX 77030, USA. hardeeps@bcm.tmc.edu
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.forename: Lindsey
authors.initials: L
authors.lastname: Wilson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.forename: Mona K
authors.initials: MK
authors.lastname: Sawhney
authors.forename: Brian
authors.initials: B
authors.lastname: Reis
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003266:Continuity of Patient Care; D055088:Early Detection of Cancer; D057286:Electronic Health Records; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D009780:Occult Blood; D014481:United States