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Published on: August 1, 2019
How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.
Shailaja Menon1, Michael W Smith1, Dean F Sittig1
1Department of Medicine, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness and Safety, the Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Houston, Texas, USA.
Healthcare organizations must address missed test results in electronic health record (EHR) systems. Specific scenarios, like trainee orders or patient assignment issues, increase risk, necessitating targeted monitoring and improved follow-up strategies.
Area of Science:
- Health Informatics
- Patient Safety
- Healthcare Management
Background:
- Electronic health records (EHRs) aim to improve test result follow-up.
- Missed test results remain a challenge in EHR-enabled healthcare settings.
- Variation exists in how facilities manage EHR-based alerts.
Purpose of the Study:
- Identify contextual factors linked to missed test results within the Veterans Affairs (VA) health system.
- Understand variations in missed test result rates across different VA facilities.
- Determine strategies associated with lower perceived risk of missed test results.
Main Methods:
- Categorized VA facilities into low (n=20) and high (n=20) perceived risk groups based on prior survey data.
- Conducted interviews with facility representatives to gather data on sociotechnical factors influencing EHR use.
- Compared contextual factors between low-risk and high-risk facilities, adjusting for structural characteristics.
Main Results:
- Facilities with low perceived risk were more likely to employ specific strategies to prevent lost alerts (p=0.0114).
- Identified three high-risk scenarios: trainee-ordered tests, surrogate clinician handoffs, and patients without assigned primary care providers (PCPs).
- Significant variability noted in policies and procedures for managing test result alerts across facilities.
Conclusions:
- Several specific scenarios increase the risk of missed test results in EHR systems.
- Healthcare organizations should implement provider-level strategies and monitoring systems to track and prevent missed test results.
- Addressing high-risk scenarios and improving test result management policies are crucial for enhancing patient safety.
