mikhail nekhline, md safwan halabi, md henry ford health system department of radiology
DESCRIPTION
The Tickler File: PACS Application Alerts Radiologists When Recommended Additional or Follow-up Examinations are Rendered. Mikhail Nekhline, MD Safwan Halabi, MD Henry Ford Health System Department of Radiology Detroit, Michigan, USA. What is a Tickler File?. - PowerPoint PPT PresentationTRANSCRIPT
The Tickler File: PACS Application Alerts Radiologists When
Recommended Additional or Follow-up Examinations are Rendered
Mikhail Nekhline, MDSafwan Halabi, MD
Henry Ford Health SystemDepartment of RadiologyDetroit, Michigan, USA
What is a Tickler File?Ordering provider: A file/list that is
maintained to alert health care providers if and when a follow-up examination is recommended for their patient
Radiologist: A file/list that is maintained to follow-up imaging recommendations and patient outcomes
Reporting and CommunicationAmerican College of Radiology (ACR)
Guidelines on ReportingEffective communication is a critical component
of diagnostic imagingCommitment and reciprocal duty of information
exchange between the ordering provider and radiologist
Emphasizes the importance of suggesting additional or follow-up studies when appropriate
Mandates the necessity to review all available pertinent previous reports and images
Radiology ReportClinical document that communicates the
imaging interpretation and recommendation of the radiologist
Clinical document that serves to guide patient care
Patient’s document that resides in the permanent medical record
Legal document for medical malpractice liability
Cleary written and/or verbally communicated to avoid ambiguity
Includes comparison and correlation to prior imaging when available
Includes recommendation for appropriate additional or follow-up examination
Final signed report with interpretation and recommendation delivered to the referring provider or clinical service
Radiology Report
Communication ShortcomingsRadiology reports and
communications are not received by the responsible parties
Significant delay between image acquisition and image interpretation
Prior imaging is not available at the time of interpretation for comparison
Referring provider assumes that other health care personnel will follow-up with the radiology recommendations
Referring provider may misinterpret the clinical significance of the imaging interpretation and/or follow-up imaging recommendations
Patient transferred care to a different facility, was lost to follow-up or was non-compliant with follow-up recommendations
Communication Shortcomings
Electronic Tickler File as a SolutionCreate exam follow-up lists and alerts
electronically at the time of image interpretation and recommendations
Ability to track all subsequent patient imaging to ensure that recommendations were acted upon
Provide feedback to the radiologist in regards to follow-up imaging results and patient outcome
Electronic Tickler File as a SolutionEnables the radiologist to become an
active participant in the care of patientsEstablishes a closer rapport with the
referring provider and clinical serviceReduces burden on the referring providerOverall goal is to deliver better patient
care and enhance patient safety
Prevent duplicate imaging exams ordered from different providers
Guide patient care and close the loop to the ordering provider and patient
Radiologist interpreting the follow-up exam will be in a better position to answer the clinical question raised on the initial exam
Limits malpractice claims
Electronic Tickler File as a Solution
Malpractice IssuesNegligence of hospital employees to
deliver a message or act upon it does not protect the radiologist from a medical malpractice claim
Failure to review prior exams for comparison or correlation may be considered as negligence
Failure to act on recommended studies may be considered a breach of duty by both the referring clinician and the radiologist
Henry Ford Health System Electronic Tickler File Solution
Illuminate plug-in (Softek Solutions, Inc.,Kansas City, KS) developed for iSite Radiology PACS (Philips, Foster City, CA)
Advanced search and data mining plug-in with functionality to create exam alertsAlert user when a key word is mentioned in a
radiology reportAlert when follow-up imaging is performed on
a specific patient
PACS plug-in allows a radiologist to track a patient when follow-up imaging is recommended
Follow-up alerts can be filtered by specific imaging modality
Alert expiration date can be designatedUser can be alerted when an exam is not
rendered by a certain date or time period
Henry Ford Health System Electronic Tickler File Solution
Alert OptionsAlerts can be received by the
radiologist and other providers via different electronic methods including: plug-in inbox, e-mail, text message, and pager
Alerts may contain the follow-up imaging report or a link to the report
Time-limited AlertsFollow-ups can be time-limited by creation
of alert expiration to ensure patient care loop closure
Alert expiration depends on the inherent nature of the suspected process, level of suspicion and radiologist preference
If no imaging of the selected modality is obtained within the allotted time period, the overdue alert notice is generated
Time-limited AlertsAlerts can be forwarded to the patient’s
provider as a reminder that the recommended follow-up examination has not been rendered
Currently, only users of the Illuminate PACS plug-in can receive the alert
Radiologist acts as the “Tickler” for the referring physician
Benefits of the Electronic Tickler File
Convenient method to electronically track follow-up recommendations at the time of interpretation
Redundant alerts can be set via various communication methods (e-mail, pager, SMS)
Alerts can be forwarded to the health care team (clinician, medical director, case worker)
Interesting studies can be tagged and archived to create a teaching file or for research purposes
Benefits of the Electronic Tickler File
Allows radiologists to read the reports and view the images of their recommended follow-up exams
Evaluates accuracy of the radiologist’s initial interpretation and validity of follow-up recommendations
Delivers feedback about the patient to the radiologist
Exposes the radiologist to the radiologic course of a disease process
Future Role of AlertsRadiologist actively participating in care
of the patient redefines role of radiology in clinical medicine
Establish call center to centrally handle all communication between the radiologist, referring physician and patient
Enhance radiology trainee education with the ability track the outcomes of their interpretations and patient outcomes
Centralized Radiology Call CenterCommunicate critical results, unexpected
findings, and missed follow-up exams to the referring physician
Reduce burden on the radiologist to track down the referring physician and maintain a central Tickler File
Document and audit all communication between the radiologist and referring provider
Radiologist as Clinical AssetTickler File empowers the radiologist to
actively participate in patient careTransfer burden of Tickler File
maintenance from the ordering provider to the radiologist
Reduce malpractice risk for the hospital and the radiologist by closing the communication loop
Add value to the radiology group to avoid risk of radiology service outsourcing
References1. ACR Practice Guideline for Communication of Diagnostic Imaging
Findings (Revised 2010)2. Berlin L. Failure of Radiologic Communication: An Increasing
Cause of Malpractice Litigation and Harm to Patients. Appl Rad 2010, Jan-Feb, 17-23
3. Cascade PN and Berlin L. Malpractice Issues in Radiology. AJR 1999;173:1439-1442
4. Chesbrough R. Critical Results: Communication Management in Radiology. http://imaging-radiation-oncology.advanceweb.com/features/article-3/critical-results-communication-management-in-radiology.aspx (posted 4/6/2010, accessed 10/1/2011)
5. Berlin L. The Duty to Communicate. AJR 2011;197 W9626. Towbin AJ, Hall S, Moskovitz J, Johnson ND, Donnelly LF. Creating
a Comprehensive Customer Service Program to Help Convey Critical and Acute Results of Radiology Studies. AJR 2011;196:W48-W51
CorrespondenceMailing address: Henry Ford HospitalDepartment of Radiology, K32799 West Grand BoulevardDetroit, MI 48202-2689
E-mail: Mikhail Nekhline: [email protected] Halabi: [email protected]