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Electronic results management in pediatric ambulatory care: qualitative assessment
Timothy G Ferris1, Sarah A Johnson, John Patrick T Co
1Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, USA. tferris@partners.org
Insights
Implementing electronic results management in pediatrics can improve test result reliability and efficiency. However, full adoption is key, as partial implementation may reduce efficiency and patient safety.
Area of Science:
- Pediatric Healthcare Informatics
- Clinical Workflow Optimization
- Health Information Technology
Background:
- Test results management in pediatrics often lacks reliability and efficiency.
- Electronic results management (ERM) is a potential solution, but its impact in pediatrics is understudied.
Purpose of the Study:
- To assess the impact of ERM on test results management in pediatric ambulatory care.
- To identify barriers and facilitators to ERM adoption in pediatric settings.
Main Methods:
- Semi-structured interviews with key informants before and after ERM implementation in 8 practices.
- Surveys of pediatricians across 18 practices (8 with ERM, 10 without).
- Assessment of baseline processes, adoption barriers, and perceived impact on quality, efficiency, and satisfaction.
Main Results:
- All practices struggled with test result tracking; none tracked all results from order to notification.
- Full ERM adopters reported improved efficiency, reliability, timeliness, and satisfaction.
- Barriers included incomplete test inclusion, poor UI design, and lack of pediatric customization. Partial adopters faced decreased efficiency and increased risk of lost results.
- Surveyed pediatricians (62% response rate) believed ERM improved care quality and efficiency, with 72% reporting safer care and 63% more-effective care.
Conclusions:
- Pediatric practices have significant room for improvement in test results management.
- ERM can enhance the efficiency and safety of managing pediatric test results.
- Partial ERM adoption poses risks to efficiency and patient safety, underscoring the need for full implementation.
Background:
Electronic results management may improve the reliability and efficiency of test results management, but few studies have investigated this topic in pediatrics.
Methods:
We conducted semi-structured, key informant interviews before and after implementation of electronic results management at 8 pediatric ambulatory care practices. We also surveyed all pediatricians at 18 practices (10 additional practices). All practices were members of Partners Healthcare and had been using an electronic health record when they were offered electronic results management. We assessed baseline processes for results management, barriers to electronic results management adoption, and the perceived impact of electronic results management on quality, efficiency, and provider satisfaction.
Results:
From interviews, we found a range of processes in place to manage test results, but all practices reported losing some results and no practice tracked all test results from the time of ordering to parent/patient notification. Practices that fully adopted electronic results management reported gains in efficiency, reliability, timeliness, and provider satisfaction, whereas some partial adopters reported decreased efficiency and increased risk of lost test results. Barriers to electronic results management adoption included lack of inclusion of all ordered tests in the electronic results management system, user interface design issues, and lack of sufficient pediatric customization. Survey results (response rate: 62%) indicated that pediatricians thought electronic results management improved the quality and efficiency of care, with 72% of pediatricians reporting safer care and 63% reporting more-effective care.
Conclusions:
We found that pediatric practices have room for improvement in the management of test results, and electronic results management may be an effective method for improving the efficiency and safety of test results management. However, partial adoption of electronic results management may decrease efficiency and pose a threat to patient safety.
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