title: Assessment of follow-up completeness and notification preferences for imaging findings of possible cancer: what happens after radiologists submit their reports?
abstract: OBJECTIVE
  To understand the reasons leading to potentially inappropriate management of imaging findings concerning for malignancy and identify optimal methods for communicating these findings to providers.
  
  
  METHODS
  We identified all abdominal imaging examinations with findings of possible cancer performed on six randomly selected days in August to December 2013. Electronic medical records (EMR) of one patient group were reviewed 3 months after the index examination to determine whether management was appropriate (completed follow-up or documented reason for no follow-up) or potentially inappropriate (no follow-up or no documented reason). Providers of a second patient group were contacted 5-6 days after imaging examinations to determine notification preferences.
  
  
  RESULTS
  Among 43 patients in the first group, five (12%) received potentially inappropriate management. Reasons included patient loss to follow-up and provider failure to review imaging results, document known imaging findings, or communicate findings to providers outside the health system. Among 16 providers caring for patients in the second group, 33% were unaware of the findings, 75% preferred to be notified of abnormal findings via e-mail or EMR, 56% wanted an embedded hyperlink enabling immediate follow-up order entry, and only 25% had a system to monitor whether patients had completed ordered testing.
  
  
  CONCLUSIONS
  One in eight patients did not receive potentially necessary follow-up care within 3 months of imaging findings of possible cancer. Automated notification of imaging findings and follow-up monitoring not only is desired by providers but can also address many of the reasons we found for inappropriate management.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: csloan@mail.med.upenn.edu.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Sloan
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Seetharam C
authors.initials: SC
authors.lastname: Chadalavada
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Tessa S
authors.initials: TS
authors.lastname: Cook
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Curtis P
authors.initials: CP
authors.lastname: Langlotz
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Schnall
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Zafar
mesh_terms: D003266:Continuity of Patient Care; D003952:Diagnostic Imaging; D006801:Humans; D033183:Interdisciplinary Communication; D016347:Medical Records Systems, Computerized; D009369:Neoplasms / Q000175:diagnosis*; D010818:Practice Patterns, Physicians' / Q000592:standards*
keywords: Follow-up; communication; continuity of patient care; physician practice patterns