Abstract
BackgroundEarly detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response.MethodsUsing both qualitative and quantitative methods, we evaluated positive FOBT communication in the electronic health record of a large, urban facility between May 2008 and March 2009. We identified the source of test result communication breakdown, and developed an intervention to fix the problem. Explicit medical record reviews measured timely follow-up (defined as response within 30 days of positive FOBT) pre- and post-intervention.ResultsData from 11 interviews and tracking information from 490 FOBT alerts revealed that the software intended to alert primary care practitioners (PCPs) of positive FOBT results was not configured correctly and over a third of positive FOBTs were not transmitted to PCPs. Upon correction of the technical problem, lack of timely follow-up decreased immediately from 29.9% to 5.4% (p < 0.01) and was sustained at month 4 following the intervention.ConclusionElectronic communication of positive FOBT results should be monitored to avoid limiting colorectal cancer screening benefits. Robust quality assurance and oversight systems are needed to achieve this. Our methods may be useful for others seeking to improve follow-up of FOBTs in their systems.
Highlights
Detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge
Problem Identification Data from primary care practitioners (PCPs) interviews and reported comments suggested that PCPs were not receiving positive FOBT alerts consistently, leading us to further investigate the processes associated with FOBT alert generation
Workflow analysis revealed that a large number of patients who are given FOBT cards never return them to the lab for processing, and an order for the test is only placed upon receipt of the card by the lab
Summary
Detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. As one of several multifaceted interventions to improve followup of positive FOBTs, our institution previously implemented standard operating procedures for the electronic health record's test result communication system [19], including the transmission of a mandatory alert to the patient's clinician for every positive FOBT result. This procedure was expected to reduce breakdowns in communication between the laboratory and clinicians
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