Documenting data delivery: design, deployment, and decision

Developing and deploying informatics solutions which are useful and acceptable to busy physicians are challenging tasks. We describe the design, deployment, and evaluation process by which the delivery of routine clinical laboratory reports is automated using electronic mail. Data from TMR, an operational computer-based patient record (CPR), are presented to providers using an individualized, modern interface. This system is compared to the existing, paper-based system for delivery of data from the same CPR. Differences between the two systems of data delivery are analyzed, with emphases on 1) electronic documentation of data delivery and receipt, 2) electronic and/or paper documentation of clinical action taken as a result of laboratory reports, 3) timeliness of report availability, 4) costs, 5) workflow compatibility, and 6) physician satisfaction. The new delivery system employs inexpensive, commercially available software applications and entails only trivial changes to the proprietary CPR. Built into the new system are features which allow quantitative measurements of its performance for analysis along with survey-based user satisfaction data. The open systems design is deliberately non-proprietary, inexpensive, and generalizable. Accordingly, it offers practical possibilities for settings in which clinical information systems are just being planned, as well as for those in which such systems are already established.