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

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

doi:10.1186/1472-6947-11-22

Abstract

BackgroundNotifying 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.MethodsWe 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.ResultsProviders 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.ConclusionProviders 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.

Highlights

Notifying clinicians about abnormal test results through electronic health record (EHR) -based “alert” notifications may not always lead to timely follow-up of patients
To achieve meaningful use of EHRs as envisioned by the federal government, providers need to be proficient in use of the decision support features available in their EHR and understand how they fit into the clinical workflow
In many EHR systems, an electronic notification feature (e.g., the “View Alert” window used by the U.S Department of Veterans Affairs’ (VA) Computerized Patient Records System (CPRS), or the “InBasket” feature available in Epic’s EpicCare EHR) delivers test results to a message inbox that providers can access after they login to the EHR

Summary

Introduction

Notifying clinicians about abnormal test results through electronic health record (EHR) -based “alert” notifications may not always lead to timely follow-up of patients. In many EHR systems, an electronic notification feature (e.g., the “View Alert” window used by the U.S Department of Veterans Affairs’ (VA) Computerized Patient Records System (CPRS), or the “InBasket” feature available in Epic’s EpicCare EHR) delivers test results to a message inbox that providers can access after they login to the EHR. Unlike actions related to DDI alerts, follow-up actions required of test results alerts are not necessarily required immediately after alert delivery. How these asynchronous alerts integrate into a provider’s workflow is largely unknown

Objectives

Methods

Results

Discussion

Conclusion