Main Session
Sep
28
PQA 03 - Digital Health Innovation and Informatics, Patient Safety & Quality, and Radiation and Cancer Biology
2544 - Process Improvement in Radiation Oncology to Enhance Timely Access to Outside Medical Records
Presenter(s)
James Matchynski, MD, PhD - University of Michigan, Ann Arbor, MI
J. I. Matchynski1,2, T. Pflederer1,2, K. M. Woch Naheedy1, E. L. Covington1, and J. R. Evans Jr1; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Department of Radiation Oncology, Veterans Affairs Ann Arbor Health System, Ann Arbor, MI
Purpose/Objective(s):
Timely access to outside medical records is essential for oncology-decision making, particularly for patients receiving care across multiple institutions. Physician reported RO-ILS (Radiation Oncology Incident Learning System) events described their frustrations with inadequacies in our traditional EHR (electronic health record) direct messaging-based process that limited the ability to organize, prioritize, and track record requests, contributing to potential delays. We aimed to implement a centralized, semi-structured workflow within our EHR to improve record acquisition efficiency and the availability of records at initial oncology visits.Materials/Methods:
A new workflow was deployed consisting of: (1) a patient-level outside record tracker using a structured data form in the EHR to initiate record requests; (2) a real-time worklist showing all incomplete record requests across all patients; (3) a standardized outside record request form within the EHR. The pilot was limited to support staff; provider-initiated direct messaging-based record requests were manually transferred into the tracker by support staff. Data was extracted 45 days pre- and post- implementation of the tracker. For post- implementation, direct messaging-based record requests that were not added to the tracker were excluded. Analyses focused specifically on imaging record requests due to reliable time stamps of receipt within the EHR. Imaging record requests were ineligible if the requested imaging record did not exist, appointment was cancelled and not rescheduled, or if the imaging record was already in our EHR at the time of request.Results:
The pre- implementation cohort included 107 eligible patients (152 imaging record requests). Post-implementation included 89 eligible patients (95 imaging record requests). Availability of required imaging records at the initial visit improved from 36% to 64% (p = .004). Median business days from imaging record request to receipt improved from 4.1 to 2.9 (p < .001). Median lead days from imaging record requests to scheduled visits increased from 6 to 10, reflecting earlier initiation of requests. Direct messages decreased (6.5 to 3.5 messages/day). Although not statistically significant, repeat direct messages for the same imaging record request fell from 26% to 13% (p = 0.052), and the maximum number of repeat direct messages per imaging record request declined from 12 to 3. The proportion of imaging records requested ultimately obtained remained stable (82% vs. 84%).Conclusion:
Implementation of a structured workflow within our EHR significantly improved the proportion of patient visits with complete outside imaging, driven by faster imaging record acquisition and earlier identification of missing studies. Redundant direct messaging decreased, and the system enables real-time operational oversight. Future direction will include involvement of providers and eventual expansion across the broader cancer center.