Electronic Health Record Trigger System Detects Delays in Treatment of Veterans Affairs Patients

An electronic health record system used in two large Department of Veterans Affairs hospitals detected 163 patients whose follow-up treatment was delayed despite abnormal test results for a thyroid-stimulating hormone. AHRQ-funded researchers developed and tested the trigger system that reviewed the records of nearly 300,000 patients being treated for hypothyroidism. Authors of the study in the Journal of General Internal Medicine concluded the trigger algorithm can support efforts to improve follow-up care. Access the abstract.

2017 Jan 30. doi: 10.1007/s11606-017-3988-z. [Epub ahead of print]

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism.

Meyer AN1, Murphy DR2, Al-Mutairi A3, Sittig DF4, Wei L2, Russo E2, Singh H2.

Author information

Abstract

BACKGROUND:

Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care.

OBJECTIVE:

To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism.

DESIGN:

We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up.

KEY RESULTS:

During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%).

CONCLUSIONS:

An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.