Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2011

Open Access 01-12-2011 | Research article

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

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

Published in: BMC Medical Informatics and Decision Making | Issue 1/2011

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
American Recovery and Reinvestment Act of 2009: 2009, Pub.L. 111-5. 1-4-2010.
2.
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. 75: 2013-2047. 1-13-2010.
3.
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. 10.1016/S1532-0464(03)00061-3.CrossRefPubMed
4.
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. 10.1197/jamia.M2280.CrossRefPubMedPubMedCentral
5.
Singh H, Thomas E, Mani S, Sittig D, Arora H, Espadas D: 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. 10.1001/archinternmed.2009.263.PubMedPubMedCentral
6.
Singh H, Thomas E, Sittig DF, Wilson L, Espadas D, Khan M: Automated Notification of Abnormal Laboratory Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?. Am J Med. 2010, 123: 238-244. 10.1016/j.amjmed.2009.07.027.CrossRefPubMedPubMedCentral
7.
8.
Graber ML, Franklin N, Gordon R: Diagnostic error in internal medicine. Arch Intern Med. 2005, 165: 1493-1499. 10.1001/archinte.165.13.1493.CrossRefPubMed
9.
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA: Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006, 145: 488-496.CrossRefPubMed
10.
Hickner J, Graham DG, Elder NC, Brandt E, Emsermann CB, Dovey S: Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Qual Saf Health Care. 2008, 17: 194-200. 10.1136/qshc.2006.021915.CrossRefPubMed
11.
Schiff GD: Introduction: Communicating critical test results. Jt Comm J Qual Patient Saf. 2005, 31: 63-5. 61PubMed
12.
Singh H, Sethi S, Raber M, Petersen LA: Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol. 2007, 25: 5009-5018. 10.1200/JCO.2007.13.2142.CrossRefPubMed
13.
Singh H, Daci K, Petersen LA, Collins C, Petersen NJ, Shethia A: Missed opportunities to initiate endoscopic evaluation for colorectal cancer diagnosis. Am J Gastroenterol. 2009, 104: 2543-2554. 10.1038/ajg.2009.324.CrossRefPubMedPubMedCentral
14.
Singh H, Kadiyala H, Bhagwath G, Shethia A, El-Serag H, Walder A: Using a multifaceted approach to improve the follow-up of positive fecal occult blood test results. Am J Gastroenterol. 2009, 104: 942-952. 10.1038/ajg.2009.55.CrossRefPubMedPubMedCentral
15.
Johnson CM, Johnson TR, Zhang J: A user-centered framework for redesigning health care interfaces. Journal of Biomedical Informatics. 2004, 38: 75-87. 10.1016/j.jbi.2004.11.005.CrossRef
16.
Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC: Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009, 16: 40-46. 10.1197/jamia.M2808.CrossRefPubMedPubMedCentral
17.
Judge J, Field TS, DeFlorio M, Laprino J, Auger J, Rochon P: Prescribers' responses to alerts during medication ordering in the long term care setting. J Am Med Inform Assoc. 2006, 13: 385-390. 10.1197/jamia.M1945.CrossRefPubMedPubMedCentral
18.
Ko Y, Abarca J, Malone DC, Dare DC, Geraets D, Houranieh A: Practitioners' views on computerized drug-drug interaction alerts in the VA system. J Am Med Inform Assoc. 2007, 14: 56-64. 10.1197/jamia.M2224.CrossRefPubMedPubMedCentral
19.
van der Sijs H, Aarts J, Van Gelder T, Berg M, Vulto A: Turning off frequently overridden drug alerts: limited opportunities for doing it safely. J Am Med Inform Assoc. 2008, 15: 439-448. 10.1197/jamia.M2311.CrossRefPubMedPubMedCentral
20.
van der Sijs H, Mulder A, Van Gelder T, Aarts J, Berg M, Vulto A: Drug safety alert generation and overriding in a large Dutch university medical centre. Pharmacoepidemiol Drug Saf. 2009, 18: 941-947. 10.1002/pds.1800.CrossRefPubMed
21.
Hysong SJ, Sawhney M, Wilson L, Sittig DF, Espadas D, Davis T: Provider management strategies of abnormal test result alerts: a cognitive task analysis. J Am Med Inform Assoc. 2010, 17: 71-77. 10.1197/jamia.M3200.CrossRefPubMedPubMedCentral
22.
Rose AF, Schnipper JL, Park ER, Poon EG, Li Q, Middleton B: Using qualitative studies to improve the usability of an EMR. J Biomed Inform. 2005, 38: 51-60. 10.1016/j.jbi.2004.11.006.CrossRefPubMed
23.
Aarts J, Ash J, Berg M: Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care. Int J Med Inform. 2007, 76: 4-13. 10.1016/j.ijmedinf.2006.05.009.CrossRef
24.
Barbour R: Doing Focus Groups. 2008, London: Sage
25.
Hysong SJ, Sawhney M, Wilson L, Sittig DF, Esquivel A, Watford M: Improving outpatient safety through effective electronic communication: A study protocol. Implementation Science. 2009, 4: 10.1186/1748-5908-4-62.
26.
Stewart DW, Shamdasani PN, Rook D: Focus Groups: Theory and Practice. 2006, Sage Publications, 2
27.
Casalino LP, Dunham D, Chin MH, Bielang R, Kistner EO, Karrison TG: Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009, 169: 1123-1129. 10.1001/archinternmed.2009.130.CrossRefPubMed
28.
Poon EG, Haas JS, Louise PA, Gandhi TK, Burdick E, Bates DW: Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004, 19: 316-323. 10.1111/j.1525-1497.2004.30357.x.CrossRefPubMedPubMedCentral
29.
Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW: "I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004, 164: 2223-2228. 10.1001/archinte.164.20.2223.CrossRefPubMed
30.
Patterson ES, Doebbeling BN, Fung CH, Militello L, Anders S, Asch SM: Identifying barriers to the effective use of clinical reminders: bootsrapping multiple methods. Journal of Biomedical Informatics. 2005, 38: 189-199. 10.1016/j.jbi.2004.11.015.CrossRefPubMed
31.
Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM: Exploring Barriers and Facilitators to the Use of Computerized Clinical Reminders. J Am Med Inform Assoc. 2005, 12: 438-447. 10.1197/jamia.M1777.CrossRefPubMedPubMedCentral
32.
Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH: Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006, 13: 547-556. 10.1197/jamia.M2042.CrossRefPubMedPubMedCentral
33.
Maltz M, Meyer J: Use of warnings in an attentionally demanding detection task. Human Factors. 2001, 43: 217-10.1518/001872001775900931.CrossRefPubMed
34.
Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH: Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc. 2007, 26-30.
35.
Sittig DF, Singh H: Eight rights of safe electronic health record use. JAMA. 2009, 302: 1111-1113. 10.1001/jama.2009.1311.CrossRefPubMed
36.
Metadata
Title
Understanding the management of electronic test result notifications in the outpatient setting
Authors
Sylvia J Hysong
Mona K Sawhney
Lindsey Wilson
Dean F Sittig
Adol Esquivel
Simran Singh
Hardeep Singh
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2011
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-11-22

Other articles of this Issue 1/2011

BMC Medical Informatics and Decision Making 1/2011 Go to the issue

Research article

Method for Assigning Priority Levels in Acute Care (MAPLe-AC) predicts outcomes of acute hospital care of older persons - a cross-national validation

Research article

Use of a health information exchange system in the emergency care of children

Research article

Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

Research article

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records

Study protocol

Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol

Software

PKreport: report generation for checking population pharmacokinetic model assumptions