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. 2011 Apr 12:11:22.
doi: 10.1186/1472-6947-11-22.

Understanding the management of electronic test result notifications in the outpatient setting

Sylvia J Hysong  1 , Mona K Sawhney, Lindsey Wilson, Dean F Sittig, Adol Esquivel, Simran Singh, Hardeep Singh
Affiliations

Understanding the management of electronic test result notifications in the outpatient setting

Sylvia J Hysong et al. BMC Med Inform Decis Mak. .

Abstract

Background: Notifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.

Methods: We conducted a qualitative study consisting of six 6-8 member focus groups (N = 44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow.

Results: Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification.

Conclusion: Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.

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Figures

Figure 1
Figure 1
Summary of coding process and analysis flow.
Figure 2
Figure 2
Most commonly cited barriers, facilitators, and suggestions for improvement, by site.
Figure 3
Figure 3
Co-occurrence analysis of participants' proposed solutions to volume-related barriers.
Figure 4
Figure 4
Example of implementing an intervention using a multidimensional approach: an additional window to better visualize "critical" notifications.
See this image and copyright information in PMC

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References

    1. American Recovery and Reinvestment Act of 2009. 2009. Pub.L. 111-5. 1-4-2010.
    1. Department of Health and Human Services. Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Interim Final Rule. pp. 2013–2047. 1-13-2010. - PubMed
    1. Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003;36:80–91. doi: 10.1016/S1532-0464(03)00061-3. - DOI - PubMed
    1. Singh H, Arora H, Vij M, Rao R, Khan M, Petersen L. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459–466. doi: 10.1197/jamia.M2280. - DOI - PMC - PubMed
    1. Singh H, Thomas E, Mani S, Sittig D, Arora H, Espadas D. et al.Timely Follow-Up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential? Arch Intern Med. 2009;169:1578–1586. doi: 10.1001/archinternmed.2009.263. - DOI - PMC - PubMed

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