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AJR Am J Roentgenol. 2014 Nov;203(5):W491-6. doi: 10.2214/AJR.14.13063.

Automated critical test result notification system: architecture, design, and assessment of provider satisfaction.

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1 Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115.



Communicating critical results of diagnostic imaging procedures is a national patient safety goal. The purposes of this study were to describe the system architecture and design of Alert Notification of Critical Results (ANCR), an automated system designed to facilitate communication of critical imaging results between care providers; to report providers' satisfaction with ANCR; and to compare radiologists' and ordering providers' attitudes toward ANCR.


The design decisions made for each step in the alert communication process, which includes user authentication, alert creation, alert communication, alert acknowledgment and management, alert reminder and escalation, and alert documentation, are described. To assess attitudes toward ANCR, internally developed and validated surveys were administered to all radiologists (n = 320) and ordering providers (n = 4323) who sent or received alerts 3 years after ANCR implementation.


The survey response rates were 50.4% for radiologists and 36.1% for ordering providers. Ordering providers were generally dissatisfied with the training received for use of ANCR and with access to technical support. Radiologists were more satisfied with documenting critical result communication (61.1% vs 43.2%; p = 0.0001) and tracking critical results (51.6% vs 35.1%; p = 0.0003) than were ordering providers. Both groups agreed use of ANCR reduces medical errors and improves the quality of patient care.


Use of ANCR enables automated communication of critical test results. The survey results confirm overall provider satisfaction with ANCR but highlight the need for improved training strategies for large numbers of geographically dispersed ordering providers. Future enhancements beyond acknowledging receipt of critical results are needed to help ensure timely and appropriate follow-up of critical results to improve quality and patient safety.


alert notification; automated system; critical test result; provider communication; satisfaction survey

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