PACS, EHR tool identifies incomplete, clinically necessary follow-up imaging

According to an accepted manuscript published in the American Journal of Roentgenology (AJR), socioeconomically disadvantaged patients are at increased risk of failure to undergo recommended follow-up imaging that referrers deemed clinically necessary.

“Initiatives for ensuring follow-up imaging completion should target the identified patient groups to reduce disparities in missed and delayed diagnoses,” wrote first author Neena Kapoor, MD, from the Center for Evidence-Based Imaging at Brigham and Women’s Hospital of Harvard Medical School in Boston, MA.

In this AJR accepted manuscript, an automated tool for communicating and tracking follow-up imaging recommended by radiologists was embedded in the PACS (Visage Imaging) and EHR (Epic Systems, Madison, WI) of a level 1 urban academic quaternary care hospital.

This tool prompted referrers to note if they deemed recommendations to be clinically necessary, then assessed if the needed follow-up imaging was performed; if said examination was not obtained within 1 month after the intended date of completion, the tool prompted a safety net team to perform further patient and referrer follow-up. Completion rates of clinically necessary follow-up imaging were computed—stratified by patient-, referrer, and imaging-related factors.

Ultimately, a closed-loop communication and tracking tool found a completion rate of radiologist-recommended follow-up imaging deemed clinically necessary by referrers of 74.8%. Independent predictors of failure of completion of the follow-up imaging included living in a socioeconomically disadvantaged neighborhood (odds ratio, 0.67), and inpatient (odds ratio, 0.25) or emergency (odds ratio, 0.09) status.

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