Laboratory and Diagnostic Test Tracking in Ambulatory Practice

In today’s ambulatory practice, clinicians and support staff manage ongoing risks across episodic patient encounters in a fast-paced, high-volume setting that makes tracking and follow-up systems vitally important for patient safety.

Laboratory and diagnostic test tracking is a high-risk process, in which standardized workflows, coupled with human factors input, can enhance patient outcomes and reduce the likelihood of delayed or missed diagnoses and other preventable harms.

From a diagnostic stewardship perspective, it is a matter of the right test for the right patient at the right time, producing results that are interpreted, communicated, and acted upon appropriately—without creating avoidable harm from overtesting, undertesting, missed results, or delayed follow-up.  This is especially evident with the increasing complexity of outpatient testing modalities, such as molecular genetic assays, cell-free DNA testing, rapid point-of-care diagnostics, and advanced cancer screenings.

Using Technology Systems

Health information technology (health IT), particularly the ability to extract specific EHR data, has improved exponentially since early adoption of the EHR and other health IT platforms. For test tracking, the automated “match process” functionality reconciles ordered tests with completed results, supporting routine proactive tracking.  Electronic trigger tools can identify records for review when patterns suggest potential missed follow-up or diagnostic delays. These “close the loop” tools are promising functionalities that positively impact test-tracking capabilities in ambulatory practice. Use of artificial intelligence is also accelerating test reconciliation and quality oversight.

The Office of the National Coordinator for Health Information Technology’s 2025 Self-Assessment: Test Results Reporting and Follow-Up can help practices optimize the safe use of an EHR for managing the test-tracking process.

Under the 21st Century Cures Act Open Notes provision, patients have access to most test results in their patient portal at the same time the practitioner receives them. Since 2024, the U.S. Department of Health and Human Services has also finalized Medicare program disincentives for healthcare practitioners found to have engaged in information blocking, thus increasing the importance of clear, consistent patient communication processes. Relying on the portal alone as a primary method of communication for abnormal test results, however, poses safety risks. Having a protocol in place for actively communicating abnormal results to patients is the best practice.

Standardized Workflow Coupled with Patient and Family Engagement

The goal of every practice is to provide optimal care for patients. Although tracking methods can differ, effectively managing patient care always includes steps to ensure appropriate test ordering, result reconciliation, practitioner review, patient notification, and a follow-up care plan based on shared decision-making.

A fully established process incorporates a standard workflow that engages the patient and/or family and includes the following actions:

• Order appropriate tests to support diagnostic stewardship.
• Engage patients and families in shared decision-making to ensure a clear understanding of the purpose of recommended tests.
• Proactively track (reconcile) the status of all test-related orders on a frequent schedule.
  • Use health IT functionality as an audit mechanism—use match processing to reconcile ordered tests with completed tests.
  • Use alternative methods if the EHR lacks this functionality or paper charts are utilized.
• Do not rely on the patient’s next appointment as the only method for test reconciliation.
• Act on all outstanding tests not received within a specified time period by contacting the patient and/or the testing center.
• Include all clinical laboratory, pathology, and diagnostic tests (such as biopsy specimens and imaging) in the reconciliation process.
• Enlist support staff in the test tracking process consistent with their scope of practice.
• Establish agreements with testing centers that require critical test results and incidental imaging findings of significance to be immediately reported by telephone and escalated to a licensed practitioner, followed by electronic transmission.
• For urgent/emergent ordered tests, maintain heightened tracking that flags the order. Reconcile results frequently to ensure time-sensitive follow-up.
• Document timely review of results by a physician or advanced practice clinician, as evidenced in the patient record.
• Do not finalize a set of tests ordered until every result has been received, reviewed, and communicated. For example, check the number of report pages (1 of 5) to verify all 5 pages are available.
• Communicate all test results to the patient as evidenced in the record:
  • Avoid using the no-news-is-good-news approach. Communicate normal and abnormal results. Instruct patients to contact the practice if they do not receive results within a specified time period.
  • Communicate normal results through the patient portal and other means (including letter templates or automated messaging systems).
  • Communicate abnormal results through active patient communication. Relying only on the patient portal poses safety risks.
  • Send a certified letter if unable to actively communicate abnormal results.
  • Follow the informed refusal process to ensure the patient understands the risks of not following up. Include those risks in the certified letter.
  • Document all correspondence to communicate test results.
• Establish contingency plans for notifying patients of critical results that require immediate follow-up when the patient cannot be reached by usual means:
  • Notify an emergency contact or next of kin.
  • Specialty practices: Notify the primary practitioner’s office for assistance.
  • Request a wellness check through local law enforcement in extreme circumstances.
  • Document all efforts to make patient contact.
  • Document follow-up care.
• Incorporate quality oversight:
  • Conduct periodic reviews of test-ordering utilization.
  • Utilize health IT audit reports on a regular basis for all phases of test-tracking management.
  • Conduct an annual self-assessment of the laboratory and diagnostic test-tracking process. Exclusively for The Doctors Company members: Guided Risk Self-Assessments.

Implementing a standardized test-tracking system can enhance staff member, practitioner, and patient experience. Practitioners have confidence that test results are managed properly—and patients actively participate in their own care. This reduces both the risk of patient harm and potential liability.

For additional assistance, contact Patient Safety and Risk Management at (800) 421-2368 or by email.