How context affects electronic health record-based test result follow-up: a mixed-methods evaluation. Issue 11 (11th November 2014)

• Record Type: Journal Article
• Authors: Menon, Shailaja; Smith, Michael W; Sittig, Dean F; Petersen, Nancy J; Hysong, Sylvia J; Espadas, Donna; Modi, Varsha; Singh, Hardeep
• Is Part Of: BMJ open. Volume 4:Issue 11(2014)
• Publication Date: 2014-11-11
• Subjects: Elecronic Health Records -- Missed Test Results -- Patient Follow-up -- Social-Technical Model -- Patient Safety -- Diagnostic Errors; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2014-005985
• Languages: English
• ISSNs: 2044-6055

Abstract

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.