Using informatics-enabled quality improvement techniques to meet health record documentation requirements in radiology reports.
PURPOSE
Medicare requires documented teaching physician involvement (attestation) in trainee-generated radiology reports. Automated attestation statement insertion in reports expedites the process but does not comply with requirements for active attestation. We evaluated an informatics-enabled quality improvement (QI) intervention to improve health record documentation requirements for active attestation.


MATERIALS AND METHODS
Institutional review board approval was not needed for this QI project performed in a 776-bed tertiary/quaternary teaching hospital. The intervention consisted of (1) policy requiring staff radiologists to actively attest to trainee-generated reports by personally activating a "macro" in the reporting system and (2) a semiautomated process to detect reports missing attestation; radiologists received daily e-mail reminders until the attestation statement was inserted. A random sample of 600 of 123,561 trainee-generated radiology reports created 17 months after the intervention (May 2011) was manually reviewed to determine attestation policy adherence. The number of attestation statements added in response to reminders throughout the entire study period was also evaluated. Trend analysis of the number of report addenda containing solely the attestation statement (proxy for missing initial attestation) was performed.


RESULTS
Of 600 reports, 594 (99%) contained the attestation statement. Monthly attestations in response to email notifications decreased from 585 to 227 by the sixth month, a 2.6-fold reduction (P < .01). No significant trend was observed the following year, indicating a sustained effect.


CONCLUSION
Informatics-enabled QI techniques resulted in 99% adherence to our teaching physician attestation policy with sustained results. Similar approaches may help improve adherence to other mandated performance measures in radiology reports.
['Prevedello|Luciano M|LM|', 'Farkas|Cameron|C|', 'Dufault|Allen|A|', 'Damiano|Maria|M|', 'Doubilet|Peter|P|', 'Khorasani|Ramin|R|']
D001900:Boston D005568:Forms and Records Control D019983:Guideline Adherence D008491:Medical Informatics Applications D016347:Medical Records Systems, Computerized D017410:Practice Guidelines as Topic D058996:Quality Improvement D011871:Radiology
quality improvement health record documentation Attestation