Physicians fail to share abnormal test results with patients in one out of every 14 medical tests, undermining the claimed efficacy of electronic medical records, according to a study released Monday. It was the use of a mix of paper and electronic records that fared worst.
"The electronic medical record doesn't magically fix the problem," said Lawrence Casalino, MD, of Weill Cornell Medical College in New York, who led the study published in this week's Archives of Internal Medicine.
Authors of the report mentioned that the new wave of electronic medical record keeping has done nothing to reduce the number of these kinds of mistakes, despite the fact that a number of advocates for the universal digitization of medical records had more or less guaranteed that it would eliminate just such errors.
And not keeping patients up-to-date on their own medical conditions is more than just a breach of trust; it can also be extremely dangerous, they noted.
"There are many steps in the testing process, which extends from ordering a test to providing appropriate follow-up," said Casalino, "An error in any one of these steps can have lethal consequences." The failure to diagnose is one of the most common causes of malpractice suits, he added.
Patients who are uninformed regarding their own condition frequently delay seeking crucial treatments - delays that can significantly affect a patient's chances of survival, he said.
Casalino's team examined more than 5,000 medical records from 23 doctors' offices and hospitals across the country. The team looked at he records to find abnormal test results for high cholesterol, diabetes and various forms of cancer. The team then cross-referenced them to determine which patients had not been notified of their conditions.
On average they found that in 7.1 percent of the cases, doctors had failed to inform patients of their test results. Many medical practices had stellar records, with physicians contacting patients with abnormal test results in 100 percent of the cases. Other practices had dismal records, failing to let their patients know about their potentially dangerous conditions in more than one out of four cases.
Perhaps most telling, the researchers observed that the doctors' offices with the worst records were those that utilized the so-called partial electronic medical records system - a mixture of electronic and old-school paper record keeping. No statistically significant difference was observed between practices using only paper records and those using only electronic records.
The good news, according to Casalino and colleagues, is that most these errors can be eliminated through simple procedural safeguards. Their report offered five, clear-cut, common-sense steps to eliminate future mistakes:
- All test results should be directed to the physician responsible for that patient.
- The physician should personally sign off on all results for his own patients.
- The practice should inform patients of all tests results, whether regular or irregular.
- Practices should have a clear and simple documentation procedure for recording which patients have been informed of their results and which haven't.
- All patients should be advised to call their doctor's office themselves if they have not heard back after a certain time interval.
"We found that very few physician practices had explicit rules for managing test results," Casalino said. "In many practices, each physician devised his or her own method. And in many cases, physicians and their staff told patients that 'no news is good news' - meaning they should assume that their test results were normal unless they are told otherwise. This is a dangerous assumption."
