Keep Track of Test Results:   Ways to Improve Risk Management and Patient Care

from Practice Update, Winter 2006

Elizabeth W. Woodcock, MBA, FACMPE, CPC

Managing test results is an important but often-broken process in many pediatric practices. Timely and accurate tracking of test results is critical to the quality of care you deliver, as well as to managing risk and patient relations. Try these tips — from low-tech methods to high-tech solutions — to improve test results management in your practice:

Put Charts in “Timeout” 

Place charts awaiting test results on a separate shelf or other specially designated area. File charts in date order using dividers to mark the day or week. Your staff can pull the charts off the shelf as test results come in and quickly spot any charts with outstanding results. Make sure to assign a staff member to review this shelf or rack weekly. If you don’t like the idea of keeping some charts out of the central file, try putting a red jacket or similar identifier on charts awaiting test results. There’s one critical drawback to filing those charts back with other records — it will be harder for staff to spot charts that are getting out of date. That’s why it may be worth a little extra effort to keep a log, as the next tip explains.

Keep a Log 

Record test orders in a log. Also note the patient’s name and a unique identifier, such as an account number. As results come in, highlight those entries with a color marker, or a fill-in color if you use an electronic spreadsheet, such as Microsoft Excel. Each week, scan the log for aging entries. Go another step by placing an asterisk or other identifier on entries after parents or guardians are contacted. A similar time-tested method is to use index cards or forms to record orders, and pull the cards or forms as results come in.

Automate the System

There are numerous test results management systems to purchase. Some vendors specialize in telephone-based systems. Some vendors sell software that loads into your PC, while others use internet-based systems. Whichever system you choose, make sure it allows staff to easily record and monitor orders, mark results, and communicate test results (or just their arrival) to parents or guardians. The system should also offer you or a nurse a way to add comments about the results. While these systems can do a great job and are a godsend for extremely busy practices, they don’t come cheap.

Use Recall

Your practice management system’s recall function, that is. Most systems feature an appointment recall function that identifies and sends reminders to parents or guardians regarding recommended future appointments (such as their child’s next well-child check). Use that recall function to record the dates that test orders should be back based on protocols, such as one week for an MRI. Then, direct all the appointment reminders to go to your practice — possibly via internal e-mail. The recall will identify the patient’s name and the test you ordered. A staff member assigned to monitor the incoming reminders can check to see if results come in and if appropriate follow-up was made.

Embrace Technology

Test results management should be a key feature of any electronic medical record (EMR). A growing number of pediatric practices are realizing the benefits of using an EMR. If you’re shopping for an EMR, carefully evaluate this feature. It should be easy to use, and incorporate all of the functionality of any manual system — recording orders and results, identifying outstanding results, and documenting — and possibly, handling — parent or guardian notifications. New federal rules allow hospitals to donate EMR software to medical practices for only 15 percent of the system’s value. The rules, which became effective in October 2006, outline how these “donations” can be made without tripping over anti-kickback law or Stark rules. If an EMR is not on the horizon, consider building a simple-but-powerful database to perform the same functions. Call your local community college to inquire about an intern who could help build it. Unless the interface is built into your existing system, your staff must still enter the information about test orders. But a simple database can easily identify outstanding orders. Plus, it can be programmed to “push” this information to you instead of you having to look for it.

No matter what system you opt for, make sure your staff understands the importance of monitoring tests results. Staff who recognize the danger of letting test results fall — even one — through the cracks are the vital components to the success of any test results management system you deploy.

Practice Management Q&A

Question: Why do parents and guardians change practices for their children’s medical care?

Answer: There are many reasons, but you may find research from the Ritz Carlton hotel chain very relevant. Ritz Carlton reports that 49 percent of its lost customers are a result of poor quality service from staff. Technical reasons (e.g., access or the quality of the facility) caused 15 percent of lost customers; price caused another 15 percent to stay away, and inattentive staff was cited by 20 percent of lost customers. Because parents and guardians typically don’t make medical decisions based on price (as a result of our insurance system), that’s all the more reason to focus on the quality of your staff. Remember, you can teach an employee to schedule an appointment, but you can’t train them to give a sincere smile. Hire right, and retain the good workers.

Practice Management Q&A

Question: Sometimes our patients have to wait a long time in the reception area to get in for their appointments. Can we waive their co-payments as a way of saying “sorry”? 

Answer: No, co-payments are required by the patient’s insurance company. However, there is no reason that you cannot stock your front desk with $5 gas or grocery store cards, complimentary parking passes, or coupons for a free coffee for the parents. In addition to deciding on what to give out, be sure you understand and improve the real problem here — you’re running late. Track how many gifts you give out and whether there are any patterns to the problem. Handing out gift cards won’t make the operations problems go away but tracking their distribution might help you spot the problem times, days of the week, or providers.