Failure to properly follow up on tests has been associated with missed diagnoses in the ambulatory setting. This survey evaluated the extent to which faulty systems limit a physician's ability to follow up after tests have been ordered. Even though the physicians worked within the highly computerized and integrated Veterans Affairs system, nearly one-third reported a clinically significant delay in establishing a diagnosis for a patient due to missed or delayed test results. In general, clinicians did not have a systematized method for following up on results (whether normal or abnormal), as has been documented in prior research, and the authors note that active systems for ensuring appropriate follow-up are needed even when an electronic medical record is present.