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BUSINESS OF
MEDICINE

nose. Having a well-articulated procedure for tracking patients’ lab,
radiology, and other test results can help mitigate this risk.
Many EHR systems can assist in automating test tracking, im-
proving both timeliness and completeness of the function. For
example, evaluate your EHR system to make sure you can gener-
ate data showing (a) all tests that have been ordered, (b) all test
results that have been received and reviewed by the ordering Your practice can use its EHR system to document cancelled and
healthcare provider, and (c) all test results that have been com- missed appointments and better manage these patients. For exam-
municated to patients. ple, your practice might use its system to generate a daily report
You may also find it helpful to have your system generate a daily showing all appointments for the previous day that were cancelled
task list that flags certain situations that could lead to risk exposure. or missed. This information will help pinpoint and streamline fol-
Circumstances that should be flagged include (a) tests ordered, but low-up communication and tracking.
no results received, (b) test results received, but not viewed by the Further, with thorough data input, the system can generate re-
healthcare provider, and (c) test results viewed by the healthcare ports showing whether follow-up has occurred, how quickly it oc-
provider, but not communicated to the patient. curred, and the outcome of the follow-up. This information
Routinely running reports to identify overlooked test results is provides evidence of the practice’s efforts on behalf of the patient.
critical, even if test results are included on your daily task list. These
reports can assist in your practice’s efforts to ensure no test results Audits
go missing or unnoticed. The situations described previously — test tracking, drug inter-
actions and allergies, and appointment cancellations and “no shows”
Drug Interaction and Allergy Alerts — are examples of common risk areas you may want to consider
Many EHRs are capable of alerting providers to potential dan- including in your practice’s performance improvement efforts.
gerous drug interactions and allergies. These alerts can sometimes Once you have selected a specific area for improvement, you will
be overwhelming; however, when implemented as part of a well- need to design and conduct an audit. An audit is a way of measuring
designed system, they can protect patients and help prevent pre- outcomes (performance metrics) against expectations that have
scribing errors. been defined in office policies, procedures, standards, or guidelines.
Work with your EHR vendor to (a) ensure your practice is real- When selecting measures to include in your audit, make sure that
izing the full potential of the system’s alert functions, and (b) tailor your office staff has a working knowledge of the data elements and
the alerts to meet the specific needs of your practice. definitions associated with your EHR. Providing the team with a
Also, it is imperative to realize that drug and allergy alerts work list of these elements and definitions when discussing possible
only if current data are available for the system to analyze. Thus, measures is helpful.
it’s important to make sure the providers in your practice are re- Information regarding evidence-based standards specific to the
viewing patients’ allergies at each office visit and updating the sys- patient population you serve and your practice’s involvement in
tem during the patient encounter. mandatory and/or voluntary quality data reporting initiatives also
is relevant to the audit that you design. At minimum, the audit
Cancelled Appointments and “No Shows” process that you implement should include the following for each
For both patient safety and liability reasons, healthcare practices measure selected:
need thorough processes for identifying, addressing, documenting,
and following up on cancelled and missed appointments — espe- • Definition: Create a clear statement of the metric to be meas-
cially in regard to noncompliant and/or difficult patients. ured. For example — “Communication of all tests results to
Although patients share in the responsibility for their care and ul- patients.”
timately need to make the effort to keep appointments, a well-doc-
umented follow-up call or letter from the practice can (a) remind • Goal: Develop a broad statement describing the intended result.
and encourage the patient to make a visit, which may ultimately af- For example — “This office will communicate the results of all
fect the patient’s outcome, and (b) establish the practice’s commit- tests to patients within an appropriate timeframe based on the
ment to ensuring the patient receives necessary care. results and the patient’s condition.”
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