But electronic record-keeping doesn't remove the human factor. A study published in the Archives of Internal Medicine has found that electronically alerting doctors of suspicious test results doesn't mean doctors will: a) open the electronically delivered alert; or b) act on it if they do. And although you would think that alerting more than one physician would reduce the chances that a patient would slip through the cracks, the study found just the opposite: Suspicious test results were less, not more, likely to be acted on presumably because each physician assumed the other doctor had taken the necessary steps. The study, by Dr. Hardeep Singh of the Veterans Affairs Medical Center in Houston and co-workers, was conducted in a Veterans Affairs outpatient facility from November 2007 to June 2008. The VA has a fairly sophisticated electronic medical records system. The study focused on reports of imaging exams -- CT scans, MRIs, mammograms, sonograms and radiograms. Under the system, when a result is abnormal and needs follow-up, an 'alert' window comes up on the doctor's computer screen. It stays there for two weeks. During the study, there were 123,638 images made. They prompted 1,196 alerts indicating something was potentially abnormal. Of the alerts, 217 (18.1 percent) were unopened after two weeks. And of the 1,196 alerts, 92 (7.7 percent) did not receive timely follow-up, such as a call to a patient or additional tests. (The definition of timely follow-up was within four weeks.) Perhaps surprising, the rates of poor follow-up were about the same for reports that were unopened and reports that were opened. But in cases when a radiologist talked to a physician about a test, follow-up was more likely. (This may have been partly because of those results being more serious than other abnormal tests, the authors said.) The study does not compare this electronic system with paperwork and word of mouth: There aren't good comparative data, the authors note. But the study does make suggestions: 1) Something must be done about the information overload doctors experience. If you're peppered with alerts from all sides, you're more likely to ignore or miss some. 2) If more than one doctor is notified, there must be a clear understanding who is the responsible party for taking the next step. 3) Alerts that haven't been opened should remain on doctors' screens for longer, the study says, 'perhaps even indefinitely, and should require the health care provider's signature and statement of action before they are allowed to drop off from the screen.' 4) The technology should do more than track whether doctors have opened alerts. They should track whether follow-up action was taken. 