Data from the National Ambulatory Medical Care Survey indicates that the average family physician sees approximately 100 office patients a week; the study also finds that this same physician orders diagnostic tests on approximately 39% of those patients. Tracking those tests during the pre-result and post-result stages, as well as tracking consults and referrals ordered, represents organizational challenges for your office.

And what if you don’t track tests, consults, or referrals? A study of office tracking errors conducted by the American Academy of Family Physicians found that 60% of all mistakes reported to them resulted in some harm to the patient and/or the practice. These include delay in care; lost time for the patient; emotional, physical, and financial distress for the patient; and emotional, financial or time distress for physician or practice.

Has your office ever experienced the following? A test result is filed in the chart before the ordering physician has a chance to review it; the chart is then filed away. This is at best a nuisance, but it can also result in serious harm. Consider this closed Princeton case: a patient underwent routine testing for a medical condition. The results of the latest annual test were filed away before the physician saw them; he dictated his letter to the primary physician based on the results of the previous year’s test, which apparently were easily visible in the chart (it seems that the current test was not). The current test showed a cancerous growth, and the physician did not find that result until the following year when he again went through the chart. Ultimately, the patient went through multiple procedures and cancer treatment but expired less than a year later. This case was also devastating financially.

Of course you want to avoid a liability suit which could result from a filing error, but there are other concerns in situations like these. It can be difficult to live with the knowledge that a patient suffered harm because a tracking and follow-up process was not assiduously followed. Your practice also may endure “bad press” by word of mouth, and it can take approximately ten years to regain your good name. This is a list of reasons for having a tracking system – there is no counterpoint list arguing for absence of a process.

Developing a system

The following will review the basics of tracking systems and methods to help you evaluate your current system. How well does it work? What would you like to improve about it? Do you, or will you, be using technology (an Electronic Medical Record System or a computer program designed to assist your tracking process). Remember: applying technology to your current process will not improve a process if it is already flawed; it will simply help you make mistakes faster. Fix the process before you computerize it.

Once you have clarified your process, what you would like to improve, and what tools you plan to use, you can go on to identify what you need to track and follow-up. Remember that errors occur in both pre- and post-result phases of the testing process.