The impact of health information technology on the management and follow-up of test results – a systematic review

Georgiou, Andrew; Li, Julie; Thomas, Judith; Dahm, Maria R.; Westbrook, Johanna I.

doi:10.1093/jamia/ocz032

Cited by 31 publications

(22 citation statements)

References 74 publications

(158 reference statements)

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“…Electronic health records (EHRs) hold promise for facilitating follow-up of abnormal results, but research indicates that EHRs alone are insufficient to improve care quality. 1 Studies have shown that follow-up is similar in systems with and without EHRs 2,3 for electronically acknowledged and unacknowledged result alerts, 4 and that delays longer than 30 days occur even for "high-priority" EHR alerts. 4 Additionally, EHRs may create new challenges for managing results due to a high volume of alerts and notifications to physicians.…”

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confidence: 99%

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Danforth

Hahn

Slezak

et al. 2019

American Journal of Kidney Diseases

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Background: Timely follow-up of abnormal laboratory results is important for high-quality care. We sought to identify risk factors, facilitators, and barriers to timely follow-up of an abnormal estimated glomerular filtration rate (eGFR) for the diagnosis of chronic kidney disease. Study Design: Mixed-methods study: retrospective electronic health record (EHR) analyses, physician interviews. Setting & Participants: Large integrated health care delivery system. Quantitative analyses included 244,540 patients 21 years or older with incident abnormal eGFRs from January 1, 2010, to December 31, 2015, ordered by 7,164 providers. Qualitative analyses included 15 physician interviews. Exposures: Patient-, physician-, and system-level factors. Outcome: Timely follow-up of incident abnormal eGFRs, defined as repeat eGFR obtained within 60 to 150 days, follow-up testing before 60 days that indicated normal kidney function, or diagnosis before 60 days of chronic kidney disease or kidney cancer. Analytical Approach: Multivariable robust Poisson regression models accounting for clustering within provider were used to estimate risk ratios (RRs) and 95% CIs for lack of timely follow-up. Team coding was used to identify themes from physician interviews. Results: 58% of patients lacked timely follow-up of their incident abnormal eGFRs (ie, had a care gap). An abnormal creatinine result flag in the EHR was associated with better follow-up (RR for care gap, 0.65; 95% CI, 0.64-0.66). Patient online portal use and physician panel size were weakly associated with follow-up. Patients seen by providers behind on managing their EHR message box were at higher risk for care gaps. Physician interviews identified system-level (eg, panel size and assistance in managing laboratory results) and provider-level (eg, proficiency using EHR tools) factors that influence laboratory result management. Limitations: Unable to capture intentional delays in follow-up testing. Conclusions: Timely follow-up of abnormal results remains challenging in an EHR-based integrated health care delivery system. Strategies improving provider EHR message box management and leveraging health information technology (eg, flagging abnormal eGFR results), making organizational/staffing changes (eg, increasing the role of nurses in managing laboratory results), and boosting patient engagement through better patient portals may improve test follow-up. Complete author and article information provided before references.

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confidence: 99%

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Danforth

Hahn

Slezak

et al. 2019

American Journal of Kidney Diseases

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“…This represents an additional workload undertaken by clinicians to perform dual acknowledgment in the inbox and patient’s notes, providing further evidence of the impact of electronic test results management activities and notifications on clinician’s workload. 9 , 51 , 55 The need for visibility among the clinical team of actions taken after reviewing results represents a challenging area of great importance for the development of safe and effective HIT systems. Through exploring WAD, additional workload was also identified as a challenge faced by advanced nursing staff with ordering rights who practice autonomously in managing test results in the absence of an EMR inbox (theme 5).…”

Section: Discussionmentioning

confidence: 99%

“…HIT plays an increasing role in the management of diagnostic test results. A wide variety of HIT-enabled interventions 9 have been designed to assist clinicians in managing test results, including computerized physician order entry, 10 electronic results acknowledgment, 11–14 automated email notifications of TPADs, 2 , 3 and electronic health record (EHR) alerts. 15 , 16 Evaluations of HIT interventions have reported improvements in awareness, communication, and access to clinical test results, 4 , 11 , 14 as well as in efficiency, response time, and the proportions of tests being followed up.…”

Section: Introductionmentioning

confidence: 99%

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Variation in electronic test results management and its implications for patient safety: A multisite investigation

Thomas

Dahm

et al. 2020

Journal of the American Medical Informatics Association

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Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

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“…10 The majority of articles examined in these systematic reviews have focussed on clinician-centred strategies or interventions with only two reviews reporting studies of patient involvement in test-results follow-up, principally in relation to online access to test-results via the Internet, 7 patient portals 10 or personal health records. 10 As the recipients of diagnostic testing, patients have a vested interest in the effective management and communication of their test-results. Furthermore, it is recognized that patients requesting or reviewing results may serve as a safety net for missed test-results.…”

Section: Follow-upmentioning

confidence: 99%

Can patients contribute to enhancing the safety and effectiveness of test‐result follow‐up? Qualitative outcomes from a health consumer workshop

Thomas

Dahm

et al. 2020

Health Expectations

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Background Missed test‐results and failure to follow‐up test‐results are major patient safety concerns. Strategies to improve test‐results management have predominantly focused on clinician‐based interventions, with patients principally involved in studies of test‐result communication preferences, the impact of patient portals or experiences with reporting processes in primary care. Objective To identify consumer perspectives and experiences of the challenges they have faced with test‐results management, through consumer participation in qualitative data analysis. Design and participants Volunteers (n = 10) were recruited to participate in a health consumer reference group workshop on test‐results management. Prior to the workshop, consumers selected topics for discussion using a preference poll. During the workshop, consumers participated in qualitative data analysis of de‐identified excerpts of previously collected interview data discussing hospital test‐results management. Researchers (n = 5) guided consumers through the analytical process and discussion of themes. Discussions were audio‐recorded and transcribed for qualitative analysis. Results Consumer‐selected topics for discussion were ‘Transitions of Care’ and ‘Access’. Consumer data analysis prompted broader discussion including lived experiences. Following the workshop, a second level of content analysis pinpointed issues with implications for patient safety highlighting that consumers were astutely aware of macrolevel ‘Systems Factors’ relating to ‘Emergency Departments’ and the health system, as well as microlevel ‘Patient Factors’ (eg patient preferences and circumstances) which impact a patient's understanding during the ‘Communication’ (clinician to patient/between clinicians) of test‐results ‘Information’ (or lack thereof). Conclusions Consumers identified the challenges patients experience with test‐results management, and our findings highlight areas for potential improvement in patient safety. Patient or public contribution Ten health consumer volunteers actively participated in the test‐results management data analysis workshop conducted in this study. Two health consumers also volunteered to read and comment on the draft manuscript.

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The impact of health information technology on the management and follow-up of test results – a systematic review

Cited by 31 publications

References 74 publications

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Variation in electronic test results management and its implications for patient safety: A multisite investigation

Can patients contribute to enhancing the safety and effectiveness of test‐result follow‐up? Qualitative outcomes from a health consumer workshop

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