@article{4090, keywords = {Diagnostic Errors, Elecronic Health Records, Missed Test Results, Patient Follow-up, Patient Safety, Social-Technical Model}, author = {Shailaja Menon and Michael W. Smith and Dean F. Sittig and Nancy J. Petersen and Sylvia J. Hysong and Donna Espadas and Varsha Modi and Hardeep Singh}, title = {How context affects electronic health record-based test result follow-up: a mixed-methods evaluation.}, abstract = {

OBJECTIVES: Electronic health record (EHR)-based alerts can facilitate transmission of test results to healthcare providers, helping ensure timely and appropriate follow-up. However, failure to follow-up on abnormal test results (missed test results) persists in EHR-enabled healthcare settings. We aimed to identify contextual factors associated with facility-level variation in missed test results within the Veterans Affairs (VA) health system.

DESIGN, SETTING AND PARTICIPANTS: Based on a previous survey, we categorised VA facilities according to primary care providers' (PCPs') perceptions of low (n=20) versus high (n=20) risk of missed test results. We interviewed facility representatives to collect data on several contextual factors derived from a sociotechnical conceptual model of safe and effective EHR use. We compared these factors between facilities categorised as low and high perceived risk, adjusting for structural characteristics.

RESULTS: Facilities with low perceived risk were significantly more likely to use specific strategies to prevent alerts from being lost to follow-up (p=0.0114). Qualitative analysis identified three high-risk scenarios for missed test results: alerts on tests ordered by trainees, alerts 'handed off' to another covering clinician (surrogate clinician), and alerts on patients not assigned in the EHR to a PCP. Test result management policies and procedures to address these high-risk situations varied considerably across facilities.

CONCLUSIONS: Our study identified several scenarios that pose a higher risk for missed test results in EHR-based healthcare systems. In addition to implementing provider-level strategies to prevent missed test results, healthcare organisations should consider implementing monitoring systems to track missed test results.

}, year = {2014}, journal = {BMJ Open}, volume = {4}, pages = {e005985}, month = {11/2014}, issn = {2044-6055}, doi = {10.1136/bmjopen-2014-005985}, language = {eng}, }