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

2020 ◽  
Vol 27 (8) ◽  
pp. 1214-1224
Author(s):  
Judith Thomas ◽  
Maria R Dahm ◽  
Julie Li ◽  
Peter Smith ◽  
Jacqui Irvine ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Diagnostic Test ◽  
Test Results ◽  
Results Management ◽  
Result Management ◽  
Test Result

Abstract 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.

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

2019 ◽  
Vol 26 (7) ◽  
pp. 678-688 ◽  
Author(s):  
Andrew Georgiou ◽  
Julie Li ◽  
Judith Thomas ◽  
Maria R Dahm ◽  
Johanna I Westbrook
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Test Results ◽  
Health It ◽  
Point Change ◽  
It Systems ◽  
Results Management ◽  
The Impact

Abstract Objective To investigate the impact of health information technology (IT) systems on clinicians’ work practices and patient engagement in the management and follow-up of test results. Materials and Methods A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. Results There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24–28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. Discussion The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information); 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum); and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. Conclusion Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.

Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up

Diagnosis ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 215-222 ◽  
Author(s):  
Maria R. Dahm ◽  
Andrew Georgiou ◽  
Robert Herkes ◽  
Anthony Brown ◽  
Julie Li ◽  
...  
Keyword(s):  
Patient Safety ◽  
Systems Approach ◽  
Digital Health ◽  
Diagnostic Testing ◽  
Care Process ◽  
Test Results ◽  
Levels Of Care ◽  
Result Management ◽  
Test Result

AbstractBackgroundDiagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication.MethodsA 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants.ResultsThe forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process.ConclusionsStakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

scholarly journals A comparative study of the utilisation of an electronic test–result management system in emergency and intensive care settings

2019 ◽  
Vol 26 (4) ◽  
pp. 3072-3087
Author(s):  
Judith Thomas ◽  
Maria R Dahm ◽  
Julie Li ◽  
Johanna I Westbrook ◽  
Andrew Georgiou
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Information Technology ◽  
Intensive Care ◽  
Health Information Technology ◽  
Health Information ◽  
Medical Record ◽  
Clinical Environment ◽  
Result Management ◽  
Test Result

The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test–result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test–result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of individual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test–result management processes need to address both the nuances of the clinical environment and accommodate the individual work practices of clinicians within that environment.

scholarly journals Test results management and distributed cognition in electronic health record–enabled primary care

2018 ◽  
Vol 25 (4) ◽  
pp. 1549-1562 ◽  
Author(s):  
Michael W Smith ◽  
Ashley M Hughes ◽  
Charnetta Brown ◽  
Elise Russo ◽  
Traber D Giardina ◽  
...  
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Distributed Cognition ◽  
Primary Care Providers ◽  
Test Results ◽  
Team Members ◽  
Electronic Health ◽  
Results Management

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

scholarly journals Health Informatics in Developing Countries: A Review of Unintended Consequences of IT Implementations, as They Affect Patient Safety and Recommendations on How to Address Them

2016 ◽  
Vol 25 (01) ◽  
pp. 70-72 ◽  
Author(s):  
A. Almerares ◽  
D. Luna ◽  
A. Marcelo ◽  
M. Househ ◽  
H. Mandirola ◽  
...  
Keyword(s):  
Information Technology ◽  
Developing Countries ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Health Informatics ◽  
Healthcare Organization ◽  
Unintended Consequences ◽  
Alert Fatigue ◽  
Available Information

SummaryBackground: Patient safety concerns every healthcare organization. Adoption of Health information technology (HIT) appears to have the potential to address this issue, however unanticipated and undesirable consequences from implementing HIT could lead to new and more complex hazards. This could be particularly problematic in developing countries, where regulations, policies and implementations are few, less standandarized and in some cases almost non-existing.Methods: Based on the available information and our own experience, we conducted a review of unintended consequences of HIT implementations, as they affect patient safety in developing countries.Results: We found that user dependency on the system, alert fatigue, less communications among healthcare actors and workarounds topics should be prioritize. Institution should consider existing knowledge, learn from other experiences and model their implementations to avoid known consequences. We also recommend that they monitor and communicate their own efforts to expand knowledge in the region.

Health Information Technology

2015 ◽  
pp. 1-22
Author(s):  
Patrick Albert Palmieri ◽  
Lori T. Peterson ◽  
Miguel Noe Ramirez Noeding
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Organizational Development ◽  
Health Information Technology ◽  
Health Information ◽  
Development Strategy ◽  
Financial Viability ◽  
System Failure ◽  
Healthcare Organizations ◽  
Safety Concerns

Healthcare organizations are increasingly willing to develop more efficient and higher quality processes to combat the competition and enhance financial viability by adopting contemporary solutions such as Health Information Technology (HIT). However, technological failures occur and represent a contemporary organizational development priority resulting from incongruent organization-technology interfaces. Technologically induced system failure has been defined as technological iatrogenesis. The chapter offers the Healthcare Iatrogenesis Model as an organizational development strategy to guide the responsible implementation of HIT projects. By recognizing the etiology of incongruent organizational interfaces and anticipating patient safety concerns, leaders can proactively respond to system limitations and identify hidden process instabilities prior to costly and consequential catastrophic events.

Responding to health information technology reported safety events: Insights from patient safety event reports

2019 ◽  
Vol 24 (3) ◽  
pp. 118-124 ◽  
Author(s):  
Katharine T Adams ◽  
Tracy C Kim ◽  
Allan Fong ◽  
Jessica L Howe ◽  
Kathryn M Kellogg ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Healthcare Systems ◽  
Healthcare Staff ◽  
Or Education ◽  
Training And Education ◽  
Safety Event ◽  
Policy Information

Objective We analyzed the described resolutions of patient safety event reports related to health information technology to determine how healthcare systems responded to these events, recognizing that certain types of solutions such as training and education have a limited impact. Methods A large database of over 1.7 million patient safety event reports was filtered to include those identified by the reporter as being related to health information technology. The resolution text was manually reviewed and coded into one or more of four categories: No Resolution, Training/Education, Policy, Information Technology-oriented solution. Results Most events (64%) did not include a resolution. Of those that did, Training/Education was the most commonly reported single or component of a multi-pronged solution (55%), followed by Information Technology (45%). Only 59 events (6% of resolutions) described more than one method of resolution. Conclusion Health information technology-related patient safety event resolutions most often described a solution that suggested additional training or education for healthcare staff, despite the recognized limitations of training and education in resolving these events. Few events suggested multiple resolution methods. Ensuring health information technology-related events are resolved and incorporate effective solutions should be a continued focus area for healthcare systems.

A comparative review of patient safety initiatives for national health information technology

2013 ◽  
Vol 82 (5) ◽  
pp. e139-e148 ◽  
Author(s):  
Farah Magrabi ◽  
Jos Aarts ◽  
Christian Nohr ◽  
Maureen Baker ◽  
Stuart Harrison ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
National Health ◽  
Comparative Review
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