MaineHealth Quality Team Addressing Critical Lab Results Reporting

Mark Parker, M.D., MaineHealth’s associate chief quality officer, recently highlighted a new project to reduce misdiagnoses across the Portland-based nonprofit health system.

MaineHealth has nine hospitals and also provides comprehensive pediatric care services, an extensive behavioral health care network, diagnostic services as well as home health, hospice and senior care services to 1.1 million residents in Maine and New Hampshire.


During a podcast hosted by the MaineHealth Accountable Care Organization, Parker, a nephrologist by training, said the effort to reduce misdiagnoses grew out of other work the quality team at MaineHealth has been doing over the past year around diagnostic excellence.

Parker said he has worked closely with colleague Bob Trowbridge, M.D., a Portland hospitalist who is a nationally recognized expert in the area of preventing diagnostic error. 

“We've had a lot of interest in this amongst clinicians and MaineHealth leadership, and it led us to form a committee in late 2023 to develop projects and efforts to reduce diagnostic error,” Parker  said. They pulled together resources such as the Safer Dx Checklist, which is promoted by many healthcare safety organizations, and also the Leapfrog Safety Group recommendations to help determine which areas they wanted to focus on. 

Parker explained why they chose to start with a project on getting timely and accurate lab results. 

“When you think about diagnostic excellence, there are a variety of ways you can approach it, but there are two broad categories of concerns in helping clinicians to come to the correct conclusion and make the correct diagnosis. One of them is the issue of inaccurate or delayed information, which leaves the clinician lacking the tools to come to the proper conclusion and to do it in a timely manner,” he said. “The other area of diagnostic excellence that we focus on is cognitive reasoning. In other words, the clinician has the information available, but for whatever reason comes to the incorrect conclusion.”

MaineHealth has projects going in both areas, but in the area of inaccurate or delayed information, they wanted to get into a project that would hopefully lead to relatively quick success.

“The reason we got into critical lab results reporting was because there's already been some effort in this area, and we decided to collaborate with colleagues who were already doing some work in this area and help them advance what they were trying to do,” he said. They began partnering with colleagues, such as Robert Carlson, M.D., the chief medical officer of MaineHealth’s NorDx clinical laboratory subsidiary, and some of the leadership at MaineHealth Medical Group, who were already beginning to tackle this problem.

The MaineHealth quality team formed a steering committee in the past few months. One area where there was already a head start is in after-hours critical value results for practices that don't have on-call providers, Parker explained. “And actually, this was a revelation to me. I've been working in this medical community for 25 years, and I did not realize that there were some small medical practices within MaineHealth who don't have on-call coverage in the overnight hours or sometimes on weekends,” he said. “So you get an answering machine and it tells you, go to the emergency room or do some such thing if you really need immediate assistance, but you don't have any way to get a call back from a provider or have someone acknowledge a test result.”

This problem was already recognized at MaineHealth Medical Group, and there have been some leaders there who were beginning the work of identifying these practices and developing some routing paths for critical lab results after hours, so that colleagues at NorDx have someone to speak to and to handle the immediate need if there is a critical result out there after hours. 

Parker said that Dr. Carlson brought up the fact that there is a closed-loop reporting system related to the new Beaker laboratory module in Epic, which would improve some efficiencies in the timing and response to lab results that are critical. The current process is that after hours if a lab result is flagged as critical and requiring reporting, it will be called by a NorDx employee or staff member out to the person on call. That leads to a lot of difficulties with some lab results, he explained. Even in the practices that have call coverage, sometimes the call coverage is listed incorrectly; sometimes the person who is receiving the call is managing multiple other problems and doesn't call back the page immediately, leading the NorDx employee to continue to call back and take a lot of valuable time. “So this closed-loop reporting system works within Epic to actually automate the contacting of providers with results through Haiku or Epic Chat,” he added. “And it allows for acknowledgement of receipt of the results so that the Nordx staff members knows that the result was received. This would not only get the results out relatively quickly and accurately but would also cut down on the churn and the effort to get the results acknowledged.”

Another aspect of the project involves further discussion of the discrimination of criticality. “What I mean by that is NorDx has some standards around critical lab results and what defines them, and what are the levels for critical results. There is some ongoing discussion about what's truly emergent and what's urgent, i.e., what needs to be discussed now and what could be discussed hours from now,” Parker said. “So there may still be some opportunity in that realm.”

With complex projects such as this, Parker stressed that it is important to have the right stakeholders at the table and to have people truly engaged and feeling like this is an important problem that they want to solve. “because you'll get down a lot of rabbit holes if you don't have those two pieces aligned,” he said. “There's a lot of enthusiasm around this. We've got participants from all our local health organizations across MaineHealth. We've got a lot of investment from the MaineHealth Medical Group leadership. NorDx and their leadership have been very interested and involved in this obviously. And we've got some initial partnership with it. So, we're in a great starting place as far as that goes.”

The second important thing, he said, is sticking to the scope of the project and starting small and then scaling it up. “As you can imagine and understand, this is a big problem, and it's not limited to the areas that I've already talked about,” Parker added. “Critical lab results reporting spans the entire spectrum of medical care, both ambulatory and acute care. It spreads into transitions of care. And there's a lot we need to do ultimately, but as I said earlier, right now we're kind of biting off what we can chew initially. We're looking for the quicker wins. And we're going to pilot in a small way and then see what we can scale up and spread.”