Reconciliation

What Works: Effective Practices for Office-based CareTracking of Test Results
Imaging Reconciliation

Recommendation: A system to reconcile ordered imaging tests.

Source: CRICO/RMF Office Practice Handbook


 Exemplary Practice

Computer-based system lists all pending tests (generated every 2-4 weeks) and acts as a double check for the practice

Benefit: Computer database with ability to track and trend diagnostic testing
In practice at: Southern Jamaica Plain Health Center (BWH), Fish Center for Women's Health (BWH), Brigham Internal Medical Associates (BWH), Brookside Community Health Center (BWH), International Clinic (BWH), Brigham and Women's at Newton Corner (BWH), Office of Dr. Skowronski (NSMC)


 Effective Practice
The practice uses a pending file process to reconcile ultrasound and bone density testing with results.
Benefits:
  • Promotes continuity and coordination of care.
  • Paper-based/cost effective.
In practice at: MIT OB/Gyn Department (MIT)


 Effective Practice
Any onsite imaging ordered but not completed is sent to the ordering provider's “Over Due Results Basket” for follow up.
Benefit: Ability to identify outstanding imagining test results using EMR.
In practice at: HVMA sites: Copley, Chelmsford, Kenmore, Lynnfield Medical Associates, Medford, Peabody, Post Office Square, Somerville, Wellesley


 Effective Practice
  • Imaging requisition slips are given to the patient for Children's Hospital.
  • A log book is managed by the LPN and reconciled daily.
  • Radiology reports are available by hard copy and mailed to the office. The physician initials the report with an additional note in EMR. The reports are filed in the paper medical record.
  • All radiology results abnormal are followed by the physician and reviewed with the patient/parents via phone or office visit.
Benefits:
  • Demonstrates that the provider reviewed and the patient is aware of the follow up plan.
  • Defensibility.
In practice at: PPOC Community Pediatrics


 Effective Practice
  • All diagnostic testing is written, scheduled, and logged on a visit ticket.
  • The log is printed monthly and reviewed by providers to verify completion of all ordered tests.
Benefits:
  • Ability to identify outstanding imaging test results.
  • Low cost.
  • Easy to implement.
In practice at: Sharon office (BIDMC), Harbor Medical Group Marblehead (NSMC), Office of Drs. Kaufman and Moynihan (NSMC)


 Effective Practice
A tickler system is used to determine that tests have been done as ordered and results have been obtained.
Benefits:
  • Ability to identify outstanding imaging test results.
  • Electronic system.
In practice at: BWH (most sites), Office of Dr. Bassaly (BWH), Office of Dr. Stubbert (BWH)


 Effective Practice
Onsite imaging available. Patients may wait for the imaging result the same day and have a follow-up treatment plan discussion with the provider. Results are documented in the LMR.
Benefit: Demonstrates that the provider reviewed, and the patient is aware of, the follow-up plan.
In practice at: Diabetic Associates (MGH)


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