Follow-up for Clinic Patients: Longitudinal Medical Record (LMR) Results Manager
Studies have shown that failure to perform timely follow up of test results is a common and widespread patient safety problem. A Partners Information Systems team led by Dr. Eric Poon, a clinical and research fellow with the BWH Division of General Medicine, addressed this important issue by developing an innovative solution to improve the efficiency and reliability of result follow up, called the Longitudinal Medical Record (LMR) Results Manager. The LMR user community consists of 24 primary care and 14 subspecialty practices.
A recent Partners survey shows that every week, PCPs need to review and act on roughly 360 chemistry results, 460 hematology results, 40 radiology and 12 pathology reports. PCPs also report spending on average 72 minutes per day on managing test results. More than half of the attending PCPs surveyed reported not being satisfied with the way that they manage test results. The LMR Results Manager offers the PCP an automated way to assist with this follow up process.
The LMR Results Manager reviews all chemistry, hematology, radiology and pathology results ordered by a clinician and highlights any abnormal and critical result. It allows clinicians to review these results in the context of the patient’s previous results, their problem and medication lists. It also allows the user to document electronically that the results have been reviewed. The PCP can forward these results with annotations to other clinicians and easily generate results letters for patients using Results Manager. The user can also sets “ticklers” for repeat testing and reminders for tasks in the future. One additional benefit is the ability to access web links to reference information related to abnormal lab results. Finally, there is a fail-safe mechanism whereby nightly e-mail reminders are generated to providers if critical labs have been filed but not acknowledged. Users can also allow colleagues to review test results on their behalf during any absences. These features should all facilitate PCPs’ ability to track and follow-up on test results in a safe, timely, and efficient manner.
This system was piloted by two Partners Primary Care clinics in from November 2002 to January 2003 and was met with great satisfaction. Currently, there is a study underway to measure the LMR Results Manager’s impact on patient safety. This project received the 2003 Massachusetts Medical Society Infotech Award in the residents/fellows category. The LMR Results Manager development team includes Tejal Gandhi, MD; David Bates, MD; Sam Wang, MD, PhD; Gil Kuperman, MD, PhD; David Kiernan, MEd; the LMR analyst team and development team; and the CDR analyst team and development team.
If you have any questions or comments, please email Eric Poon, MD. If you have any patient safety questions or concerns, please email Tejal Gandhi, MD or Erin Graydon-Baker.