Managing Critical Test Results

By Mark Palacio
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Mark Palacio is Executive Editor of Applied Radiology.

Even though a radiology report has been dictated and signed off, the radiologist’s responsibility in the care of that particular patient is not completed. At the annual meeting of the Radiological Society of North America in December 2009, the management of test results, particularly those deemed critical, took center stage. The issue is not limited to so-called “critical” results but also extends to documenting the follow-up of additional unexpected findings, those incidental pulmonary nodules or indeterminate renal masses. In the past, there had been a convoluted, and manual, database of referring physician phone numbers, fax numbers and emails. The end resultis that it was simple for results to be communicated but not be followed-up and radiology departments had little method to track these communications or to track the turnaround time, leaving radiologists at tremendous liability if the reports were not read or followed-up, especially if that led to harm to the patient.

Documenting results

The traditional manner of documenting critical test results, and the reality at many practices, is to record this communication in some form of log book.

“Everyone in the past did an OK job in terms of making sure that a critical result was communicated, but I think they were unable to produce reports that allowed them to satisfy Joint Commission requirements,” said Terence Matalon, MD, Chairman of Diagnostic Radiology, Albert Einstein Medical Center Healthcare Networks, Philadelphia, PA. “More concerning is that the old standards did not employ an escalation or fall-back procedure if a communication was not received.”

In the Carestream Health portfolio, the critical results loop is looked at as a completely closed cycle, according to Elad Benjamin, General Manager, Healthcare Information Systems, Carestream Health, Rochester, NY. There is a built-in RIS module which is integrated with the PACS, that enables the complete cycle during the reading process. The CTRM cycle is enabled through a series of notifications which are also integrated into the referring physician viewer.

“We see a clear convergence between the RIS and the PACS and critical results notification is a crucial part of delivering results to the end user in the appropriate time frame,” said Markus Lusser, Senior Vice President of Global Sales and Services at Carestream Health.

Implementing CTRM

There are other solutions that exist to discretely manage CTRM communications. Nuance Healthcare, Burlington, MA, offers the Veriphy™ solution for automating these transactions. Additionally, the software tracks turnaround time, verifies receipt of critical test results, and can potentially increase physician satisfaction with the communication of these results.

For instance, at Albert Einstein Medical Center, there are now 3 levels of acuity for results: hyperacute, urgent but not emergent, and significant findings. Hyperacute are immediately communicated, urgent findings are communicated within 1 hour and significant findings are communicated within 3 days.

“From my clinicians’ perspectives, they now know whether they are getting an urgent or a significant finding, and they appreciate that distinction over the prior method of direct telephone conversations, because they would often get notified of significant findings that were not urgent.” said Dr. Matalon.

One of the challenges of implementing CTRM is also changing the practices of referring physicians.

“When we implement a CTRM solution in the enterprise it is disruptive at first, because there is a brand new set of communications going out to the community, which may have previously received direct phone calls, and now it’s a page, e-mail or text,” said Christopher Click, Senior Director, Diagnostic Solutions, Nuance Healthcare. “According to what we see at RSNA and other industry forums there is a need for these solutions. But it must fit into the referring physician and radiologist workflow. One of the ways to increase utilization is to have an absolute requirement that this solution will be used in the institution.”


CTRM solutions are going to play an increasing role in the way radiology practices communicate with their constituents. According to Click, most healthcare facilities are still using a manual process for tracking these communications, and no more than 10% of the marketis using an automated solution for the notification, validation of receipt and recording the path of the result. Recognizing the importance of this issue, Applied Radiology recently conducted an interactive Expert Forum on Critical Test Results Management, Structured Reporting and Radiology Lexicons. To view the archived presentation or snippets of the Q&A discussion, visit

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Managing Critical Test Results.  Appl Radiol. 

October 18, 2010
Categories:  Imaging Informatics

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