Automated alerts keep physicians abreast of urgent findings

Radiology departments are adding value to their reports by automating the communication of important findings to referring physicians.

"Our work product is not just the pretty pictures we create," said Dr. Dan Cohen, a radiology resident at Massachusetts General Hospital. "It is the interpretation we provide."

Cohen and colleagues developed a system to notify their requesting physicians of urgent findings. The alert is triggered by the radiologist and sent via e-mail to the referring physician. It does not contain the actual exam results but instead provides a link to them, Cohen said.

To avoid desensitizing physicians to the alerts, they are not used for minor findings.

During an eight-month period, radiologists at MGH completed over 390,000 exams and sent 8210 alerts. Over 70% of these were viewed by physicians, but more than 20% of the alerts did not generate return receipts, indicating that physicians may not have opened or received them.

In a survey, physicians listed several reasons for missing the alerts: They had already seen the important finding in the HIS, they had never ordered a particular study, the patient was no longer their patient, or their systems were outside the hospital's firewall.

These missed alerts could be reduced by hiring dedicated personnel to follow up and make sure that physicians receive and respond to them, Cohen said.

Dr. Matthew Morgan of the University of Pittsburgh Medical Center described four different urgency levels used in his department:

• Category 1 findings need high levels of attention and involve life-threatening findings, and minutes count in patient management. These findings require immediate synchronous communication.

• Category 2 findings also need high levels of attention but can be managed in minutes to hours. They require reliable asynchronous communication such as e-mail.

• Category 3 findings can be treated before the sun sets. They can be communicated via synchronous/interrupted modes of communication.

• Category 4 findings are needle in the haystack findings and do not warrant high levels of attention. Goals for communication for these types of findings include allowing a physician to see a list of patient reports and to identify those reports containing important findings. Communication could be conducted through a radiology Web portal for physicians.

The software developed at the institution provides context-specific messaging for each different type of communication, according to Morgan.

"One-size communication does not fit all," he said.