Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

Singh, Hardeep; Spitzmüeller, Christiane; Petersen, Nancy J.; Sawhney, Mona; Smith, Michael W.; Murphy, Daniel R.; Espadas, Donna; Laxmisan, Archana; Sittig, Dean F.

doi:10.1136/amiajnl-2012-001267

Cited by 73 publications

(76 citation statements)

References 54 publications

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“…Our response rate was considerably lower than a prior study of VA PCPs (51.8%) conducted by Singh and colleauges. 40 However, on the one hand, because the recruitment process is not described in the study by Singh et al, it is unclear how our recruitment process might have differed. On the other hand, our response rate of 13% was higher than a recent study 41 designed to examine the effect of incentives on physician response to Internet surveys wherein 11.4% responded to at least one question and only 8.5% completed the entire survey.…”

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confidence: 93%

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Ulmer

Bosworth

Beckham

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions. Methods: A survey was conducted within the VA health care system. Primary care providers completed surveys electronically. Results: A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%). Conclusions: Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia. Commentary: A commentary on this article appears in this issue on page 937.

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confidence: 93%

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Ulmer

Bosworth

Beckham

et al. 2017

Journal of Clinical Sleep Medicine

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“…A lack of understanding of these notification functions on the part of the laboratory, and/ or poor coordination with EHR support personnel, can lead to outcomes that might include (1) ordering clinicians being unaware of new results, (2) results being routed to the incorrect clinician, or (3) test result notifications not being delivered to any clinician. [24][25][26][27][28] Key questions for pathologists to ask about the EHR test notification function are listed in Table 3.…”

Section: Cp Results In the Ehrmentioning

confidence: 99%

Management of Laboratory Data and Information Exchange in the Electronic Health Record

Wilkerson

Henricks

Castellani

et al. 2015

Archives of Pathology & Laboratory Medicine

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In the era of the electronic health record, the success of laboratories and pathologists will depend on effective presentation and management of laboratory information, including test orders and results, and effective exchange of data between the laboratory information system and the electronic health record. In this third paper of a series that explores empowerment of pathology in the era of the electronic health record, we review key elements of managing laboratory information within the electronic health record and examine functional issues pertinent to pathologists and laboratories in the exchange of laboratory information between electronic health records and both anatomic and clinical pathology laboratory information systems. Issues with electronic order-entry and results-reporting interfaces are described, and considerations for setting up these interfaces are detailed in tables. The role of the laboratory medical director as mandated by the Clinical Laboratory Improvement Amendments of 1988 and the impacts of discordance between laboratory results and their display in the electronic health record are also discussed.(Arch Pathol Lab Med. 2015;139:319-327; doi: 10.5858/arpa.2013-0712-SO) L aboratory information systems (LISs) are designed to meet workflow needs within the laboratory as well as interface with electronic health record (EHR) and billing systems. Configuration and maintenance of appropriate communication between an LIS and an EHR are very much institution dependent and beyond the scope of this document; however, understanding the complexity of the problem is not.Although anatomic pathology (AP) and clinical pathology (CP) specimens, workflows, and results reporting share many common electronic communications issues, the complexity of the LIS-EHR data flow problem is increased as AP and CP each also have unique information management requirements. Most institutions will have an AP LIS (APLIS) to handle data and workflows related to testing of surgical and cytology specimens, as well as a separate CP LIS (CPLIS) to facilitate testing and reporting of blood and other specimen types. In an attempt to more effectively address these complexities, we will first examine shared issues and then explore issues unique to each type of system. ISSUES SHARED BETWEEN APLIS AND CPLIS Patient IdentificationPositive patient identification is essential at every step of the care life cycle, from the time a patient presents to a clinic through ordering, phlebotomy or biopsy, testing, result transmission, result review, billing, and taking action based on a result. Unique patient identifiers that always associate patient identity with the correct patient data are a crucial problem that has not yet been successfully addressed by legislation. This association is critical when an LIS transmits patient data across multiple institutional, office, health information exchange, and personal health records, as well as state and federal registries for mandatory reporting (eg, communicable infectious diseases for population su...

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“…26 Most primary care physicians see hundreds of tests per week, and volume alone is a challenge. 12 Implementing systems whereby test results are routinely "pushed out" to patients has been proposed as one way to ensure that important results are not missed. Ignoring the patient safety benefits that might accrue from routinely conveying test results to patients, patients consistently report that they want to know their test results whether normal or abnormal.…”

Section: Discussionmentioning

confidence: 99%

“…11 It would not be an overstatement to conclude that the health care system lacks mechanisms for ensuring that test results are consistently conveyed to patients. 3,12 As appreciation of problems inherent in test result reporting processes has increased, a number of potential solutions have been explored. One strategy has involved the development of advanced computerized in-boxes that assist providers in reviewing results, initiating actions (e.g., referrals, office visits) for abnormal results, and notifying patients.…”

Section: Introductionmentioning

confidence: 99%

Patient Preferences for Test Result Notification

Shultz

Matelski

et al. 2015

J GEN INTERN MED

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IMPORTANCE:Patients are increasingly being given access to their test results, but little is known about how preferences vary with the test under consideration or the results of the test (normal or abnormal). OBJECTIVE: This study was conducted to examine preferences for test result communication. DESIGN, SETTING, AND PARTICIPANTS: We surveyed adults to explore their preferences for test result notification for three common diagnostic tests of varying "emotional impact" (dual-energy x-ray absorptiometry [DXA], genital herpes, and cancer biopsy) when test results were 1) normal and 2) abnormal. We conducted our survey between June and August 2012 on the campus of an academic medical center. For each scenario, subjects were asked to rank seven methods that might be used to communicate test results (letter, unsecured email, secured email, text message, telephone call, secure Web portal, office visit) in order of acceptability. MAIN OUTCOME MEASURES: The main measures were the percentage of respondents who ranked a particular test result notification method favorably and the percentage who ranked it as unacceptable. RESULTS: When test results were normal, subjects' notification preferences were generally similar for DXA, herpes and cancer biopsy, with telephone and letter ranked most favorably for all three tests. Conversely, text message and unsecured email were viewed as unacceptable notification methods for normal results by 45.0-55.0 % of subjects across all three tests. When test results were abnormal, office visits became more popular. A higher proportion of subjects ranked office visits as their most preferred notification method for our test with high "emotional impact" (cancer biopsy) (38.4 %) as compared to DXA (28.2 %) and herpes (27.9 %) (P=0.02). For most test scenarios, younger subjects appeared to rank electronic communication modalities (secure email or Web portal) higher than older subjects, though this difference did not reach statistical significance (P=0.29). CONCLUSIONS: Preferences for test result notification can differ substantially depending upon the test under consideration and results of the test. Providers and health care systems should consider these factors when deciding how to communicate results to patients.

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Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

Cited by 73 publications

References 54 publications

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Management of Laboratory Data and Information Exchange in the Electronic Health Record

Patient Preferences for Test Result Notification

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