Technology-Based Closed-Loop Tracking for Improving Communication and Follow-up of Pathology Results

Suja S. Rajan, PhD, MHA, MS,* Jessica L. Baldwin, MPH,†‡
Traber D. Giardina, PhD, MSW,†‡ and Hardeep Singh, MD, MPH†‡

Objective: Failure to follow up on laboratory test results can lead to missed diagnoses, diagnostic delays, patient harm, and potential malpractice claims against providers. State-of-the-art tracking technologies such as the radio frequency identification (RFID) can potentially improve laboratory order processing and test result communication. We conducted a comparative evaluation of differences in completion rates for 5 testing process milestones and time to reach these process milestones, with and without RFID order tracking for skin biopsy orders.
Methods: This observational study analyzed 48,515 orders from 20 dermatology providers, sent to 8 pathology laboratories in 2016 to 2017. Descriptive t tests and multiple Cox proportional hazard regressions were used to examine the differences in completion rates and times to the 5 testing process milestones, namely, (1) provider receipt of results, (2) provider re-view of results, (3) patient notification, (4) follow-up scheduling, and (5) or-der case closure, for orders processed with and without RFID order tracking.
Results: Descriptive statistics illustrated that all 5 testing process mile-stone completion rates were statistically higher for RFID tracked orders compared with non-RFID tracked orders, and RFID tracked orders took 3 to 5 days lesser than non-RFID tracked orders to reach the 5 testing pro-cess milestones. Multiple cox proportional hazard regressions showed that the process milestones were achieved faster if orders were RFID tracked versus not (hazard ratios ranged from 1.3 to 4.9).
Conclusions: The RFID tracking technology considerably improved test result communication timeliness and reliability. Such technologies can be beneficial for laboratory order processing, and their effectiveness should be explored in other practice settings.
Key Words: patient safety, diagnosis, testing, information technology, laboratory medicine
(J Patient Saf 2020;00: 00–00)

From the *Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston; †Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center; and ‡Department of Medicine, Baylor College of Medicine, Houston, Texas.
Correspondence: Suja S. Rajan, PhD, MHA, MS, Department of Management,

Policy & Community Health, School of Public Health, University of Texas Health Science Center at Houston, Rm E915, 1200 Pressler St, Houston, TX 77030 (e‐mail:

Institutional review board approval status: The local institutional review board exempted this study from a review. Dr Singh is funded in part by the Houston Veterans Administration (VA) Health

Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety (CIN13-413), the VA HSR&D Service (CRE17-127 and the Presidential Early Career Award for Scientists and Engineers USA 14-274), the VA National Center for Patient Safety, the Agency for Healthcare Research and Quality (R01HS27363), the CanTest Research Collaborative funded by a Cancer Research UK Population Research Catalyst award (C8640/A23385) and the Gordon and Betty Moore Foundation. Complete.MD had no involvement in funding; study design; collection, analysis, or interpretation of the data; writing the report; or the decision to submit the manuscript for publication.

The authors disclose no conflict of interest.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


Order Processing and the RFID Tracking Technology

A practice management system, Complete.MD, adopted the RFID technology in their “Pathology Tracker” software module to track certain laboratory specimens processed by 1 of their 8 pathology laboratories (the other 7 laboratories did not use the RFID technology).8,9 The goal of adopting the RFID technology was to improve order tracking, specimen processing, and test result communication to clinicians and patients. Both RFID tracked and non–RFID tracked orders were processed through the Pathology Tracker by these laboratories.
Figures 1 and 2 illustrate the process maps for RFID and non-RFID tracked orders, respectively. For both types of orders, once a skin biopsy order is created by a provider, information about the order is electronically scanned and transmitted to a laboratory, so the laboratory can facilitate a courier pick-up. After the laboratory receives the specimen and performs the test, the results are sent back to the provider. This is followed by provider review, patient notification, and patient follow-up (if needed). Eventually, the order case is closed. The timestamps for these process steps are electronically recorded in the Complete.MD system for both RFID and non-RFID tracked orders, as both types of orders are tracked through the Pathology Tracker software. Timestamps for certain process steps in the system are created automatically because the orders are scanned when the orders move from the providers to laboratories and back. These process steps include “order ready for courier pick-up from a provider” and “provider receipt of results.” Other timestamps are entered by clinicians and staff. These include “provider review of results,”“patient notification,” “follow-up scheduling,” and “order case closure.”
The RFID technology places providers, laboratory professionals, and patients on a central cloud platform, in order to facilitate processing, communication, and accountability. RFID tracked orders have the following advantages over non-RFID tracked orders: (1) facilitation of order scanning in batches, thereby enabling diagnosis and effective patient management.1 Failure to close the loop on follow-up of laboratory test results can lead to patients not being informed of abnormal results, patient harm due to missed diagnoses or diagnostic delays, and potential malpractice claims against clinicians.2–6 State-of-the-art tracking technologies can streamline laboratory specimen processing and improve communication of test results, thereby preventing delays.2,3,7 Although tracking technologies such as the radio frequency identification (RFID) have been used by shipping and courier ser-vices8 for tracking packages, they have not been applied to laboratory specimen processing. We used data from the initial implementation of RFID technology in a group of pathology laboratories in 2016 and 2017, and evaluated the effect of the RFID technology on timely processing of skin biopsy orders and communication of test results.

Process map for RFID tracked orders.
FIGURE 1. Process map for RFID tracked orders. This figure presents a flowchart depicting the flow of laboratory orders through an RFID tracking system. The asterisks indicate process steps that are different in the processing of RFID versus the non-RFID tracked orders.