Dataset Information

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

ABSTRACT:

Objectives

Electronic health record (EHR)-based alerts can facilitate transmission of test results to healthcare providers, helping ensure timely and appropriate follow-up. However, failure to follow-up on abnormal test results (missed test results) persists in EHR-enabled healthcare settings. We aimed to identify contextual factors associated with facility-level variation in missed test results within the Veterans Affairs (VA) health system.

Design, setting and participants

Based on a previous survey, we categorised VA facilities according to primary care providers' (PCPs') perceptions of low (n=20) versus high (n=20) risk of missed test results. We interviewed facility representatives to collect data on several contextual factors derived from a sociotechnical conceptual model of safe and effective EHR use. We compared these factors between facilities categorised as low and high perceived risk, adjusting for structural characteristics.

Results

Facilities with low perceived risk were significantly more likely to use specific strategies to prevent alerts from being lost to follow-up (p=0.0114). Qualitative analysis identified three high-risk scenarios for missed test results: alerts on tests ordered by trainees, alerts 'handed off' to another covering clinician (surrogate clinician), and alerts on patients not assigned in the EHR to a PCP. Test result management policies and procedures to address these high-risk situations varied considerably across facilities.

Conclusions

Our study identified several scenarios that pose a higher risk for missed test results in EHR-based healthcare systems. In addition to implementing provider-level strategies to prevent missed test results, healthcare organisations should consider implementing monitoring systems to track missed test results.

SUBMITTER: Menon S

PROVIDER: S-EPMC4244393 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Publications

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

Menon Shailaja S Smith Michael W MW Sittig Dean F DF Petersen Nancy J NJ Hysong Sylvia J SJ Espadas Donna D Modi Varsha V Singh Hardeep H

BMJ open 20141111 11

<h4>Objectives</h4>Electronic health record (EHR)-based alerts can facilitate transmission of test results to healthcare providers, helping ensure timely and appropriate follow-up. However, failure to follow-up on abnormal test results (missed test results) persists in EHR-enabled healthcare settings. We aimed to identify contextual factors associated with facility-level variation in missed test results within the Veterans Affairs (VA) health system.<h4>Design, setting and participants</h4>Based ...[more]

PMID: 25387758

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Dataset Information

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

Objectives

Design, setting and participants

Results

Conclusions

Publications

How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.

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