scholarly journals Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record

2015 ◽  
Vol 22 (4) ◽  
pp. 905-908 ◽  
Author(s):  
Anuj K Dalal ◽  
Bailey M Pesterev ◽  
Katyuska Eibensteiner ◽  
Lisa P Newmark ◽  
Lipika Samal ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Safety Concern ◽  
Test Results ◽  
Ambulatory Patient ◽  
Health Records ◽  
Closing The Loop ◽  
Electronic Health ◽  
Clinically Significant ◽  
Test Result

Abstract Failure to follow-up nonurgent, clinically significant test results (CSTRs) is an ambulatory patient safety concern. Tools within electronic health records (EHRs) may facilitate test result acknowledgment, but their utility with regard to nonurgent CSTRs is unclear. We measured use of an acknowledgment tool by 146 primary care physicians (PCPs) at 13 network-affiliated practices that use the same EHR. We then surveyed PCPs to assess use of, satisfaction with, and desired enhancements to the acknowledgment tool. The rate of acknowledgment of non-urgent CSTRs by PCPs was 78%. Of 73 survey respondents, 72 reported taking one or more actions after reviewing a CSTR; fewer (40–75%) reported that using the acknowledgment tool was helpful for a specific purpose. Forty-six (64%) were satisfied with the tool. Both satisfied and nonsatisfied PCPs reported that enhancements linking acknowledgment to routine actions would be useful. EHR vendors should consider enhancements to acknowledgment functionality to ensure follow-up of nonurgent CSTRs.

scholarly journals Improving follow-up of abnormal cancer screens using electronic health records: trust but verify test result communication

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Hardeep Singh ◽  
Lindsey Wilson ◽  
Laura A Petersen ◽  
Mona K Sawhney ◽  
Brian Reis ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Health Records ◽  
Electronic Health ◽  
Test Result

scholarly journals Validating Laboratory Results in Electronic Health Records: A College of American Pathologists Q-Probes Study

2016 ◽  
Vol 140 (9) ◽  
pp. 926-931 ◽  
Author(s):  
Peter L. Perrotta ◽  
Donald S. Karcher
Keyword(s):  
Great Majority ◽  
Reference Laboratory ◽  
Test Results ◽  
Health Records ◽  
Laboratory Test Results ◽  
Laboratory Results ◽  
Electronic Health ◽  
Lower Test ◽  
Pathology Reports ◽  
Test Result

Context.—Laboratories must ensure that the test results and pathology reports they transmit to a patient's electronic health record (EHR) are accurate, complete, and presented in a useable format. Objective.—To determine the accuracy, completeness, and formatting of laboratory test results and pathology reports transmitted from the laboratory to the EHR. Design.—Participants from 45 institutions retrospectively reviewed results from 16 different laboratory tests, including clinical and anatomic pathology results, within the EHR used by their providers to view laboratory results. Results were evaluated for accuracy, presence of required elements, and usability. Both normal and abnormal results were reviewed for tests, some of which were performed in-house and others at a reference laboratory. Results.—Overall accuracy for test results transmitted to the EHR was greater than 99.3% (1052 of 1059). There was lower compliance for completeness of test results, with 69.6% (732 of 1051) of the test results containing all essential reporting elements. Institutions that had fewer than half of their orders entered electronically had lower test result completeness rates. The rate of appropriate formatting of results was 90.9% (98 of 1010). Conclusions.—The great majority of test results are accurately transmitted from the laboratory to the EHR; however, lower percentages are transmitted completely and in a useable format. Laboratories should verify the accuracy, completeness, and format of test results at the time of test implementation, after test changes, and periodically.

scholarly journals Rationale and design of the Novel Uses of adaptive Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) pragmatic adaptive randomized trial: a trial protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Julie C. Lauffenburger ◽  
Thomas Isaac ◽  
Lorenzo Trippa ◽  
Punam Keller ◽  
Ted Robertson ◽  
...  
Keyword(s):  
Older Adults ◽  
Usual Care ◽  
Behavioral Science ◽  
Inappropriate Prescribing ◽  
The Novel ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Stage 1

Abstract Background The prescribing of high-risk medications to older adults remains extremely common and results in potentially avoidable health consequences. Efforts to reduce prescribing have had limited success, in part because they have been sub-optimally timed, poorly designed, or not provided actionable information. Electronic health record (EHR)-based tools are commonly used but have had limited application in facilitating deprescribing in older adults. The objective is to determine whether designing EHR tools using behavioral science principles reduces inappropriate prescribing and clinical outcomes in older adults. Methods The Novel Uses of Designs to Guide provider Engagement in Electronic Health Records (NUDGE-EHR) project uses a two-stage, 16-arm adaptive randomized pragmatic trial with a “pick-the-winner” design to identify the most effective of many potential EHR tools among primary care providers and their patients ≥ 65 years chronically using benzodiazepines, sedative hypnotic (“Z-drugs”), or anticholinergics in a large integrated delivery system. In stage 1, we randomized providers and their patients to usual care (n = 81 providers) or one of 15 EHR tools (n = 8 providers per arm) designed using behavioral principles including salience, choice architecture, or defaulting. After 6 months of follow-up, we will rank order the arms based upon their impact on the trial’s primary outcome (for both stages): reduction in inappropriate prescribing (via discontinuation or tapering). In stage 2, we will randomize (a) stage 1 usual care providers in a 1:1 ratio to one of the up to 5 most promising stage 1 interventions or continue usual care and (b) stage 1 providers in the unselected arms in a 1:1 ratio to one of the 5 most promising interventions or usual care. Secondary and tertiary outcomes include quantities of medication prescribed and utilized and clinically significant adverse outcomes. Discussion Stage 1 launched in October 2020. We plan to complete stage 2 follow-up in December 2021. These results will advance understanding about how behavioral science can optimize EHR decision support to improve prescribing and health outcomes. Adaptive trials have rarely been used in implementation science, so these findings also provide insight into how trials in this field could be more efficiently conducted. Trial registration Clinicaltrials.gov (NCT04284553, registered: February 26, 2020)

USE OF ELECTRONIC HEALTH RECORDS TO CHARACTERIZE A RARE DISEASE IN THE U.S.: TREATMENT, COMORBIDITIES, AND FOLLOW-UP TRENDS AMONG PATIENTS WITH A CONFIRMED DIAGNOSIS OF ACROMEGALY

2018 ◽  
Vol 24 (6) ◽  
pp. 517-526 ◽  
Author(s):  
Julie M. Silverstein ◽  
Erin D. Roe ◽  
Kashif M. Munir ◽  
Janet L. Fox ◽  
Birol Emir ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Rare Disease ◽  
Health Records ◽  
Electronic Health ◽  
The U.S

Exploration of Ambulatory Care Physician Phenotypes for Electronic Health Record Use (Preprint)

2021 ◽  
Author(s):  
Allan Fong ◽  
Mark Iscoe ◽  
Christine A Sinsky ◽  
Adrian Haimovich ◽  
Brian Williams ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Primary Care Physicians ◽  
Ad Hoc ◽  
Care Physician ◽  
Machine Learning Technique ◽  
Health Records ◽  
Physician Practices ◽  
Learning Technique ◽  
Average Work ◽  
Electronic Health

BACKGROUND Electronic health records (EHRs) have become ubiquitous in United States office-based physician practices. However, the different ways users engage with EHRs remains poorly characterized. OBJECTIVE The objective of this paper is to explore EHR usage phenotypes amongst ambulatory care physicians. METHODS We applied affinity propagation, an unsupervised clustering machine learning technique, to identify EHR user types amongst primary care physicians. RESULTS We identified four distinct clusters generalized across internal medicine, family medicine, and pediatric specialties. Two groups, or phenotype clusters, of physicians with higher-than-average work outside of scheduled hours ratios had varied EHR usage suggesting one group may have worked from home out of necessity while the other preferred ad hoc work hours. From the two remaining groups, one group represented physicians with lower-than-average EHR time. The last group represented physicians who spend the largest proportion of their EHR time documenting notes. CONCLUSIONS These findings demonstrate the utility of cluster analysis for exploring EHR phenotypes and may offer opportunities for interventions to improve EHR design and use to better support EHR users’ needs.

A Simple Web-Based Image Database System for Facilitating Medical Care in Dermatological Clinics

2012 ◽  
pp. 502-513
Author(s):  
Takeshi Toda ◽  
PaoMin Chen ◽  
Shinya Ozaki ◽  
Kazunobu Fujita ◽  
Naoko Ideguchi
Keyword(s):  
Image Database ◽  
Database System ◽  
Medical Examination ◽  
Easy Access ◽  
Health Record ◽  
Health Records ◽  
Web Based ◽  
Internet Server ◽  
Electronic Health

In Japan, electronic health record systems are gradually becoming popular at large hospitals, but are not yet frequently implemented in clinics. This is due to both prohibitive costs and a lack of interest in checking electronic health records on the part of patients. Doctors also may be opposed to showing patients their health records, as it then may require a doctor to let patients observe images to check for improvement of symptoms at follow-up. In this study, the authors developed a database system of dermatological images accessible to both doctors and patients. In this system, doctors can photograph affected skin areas and tag the images with keywords, such as patient ID or name, disease or diagnosis, symptoms, affected bodily regions, and free wards. The images and keyword tags are transmitted to a database housed on an Internet server. The authors implemented this system on a smartphone for quick and easy access during medical examination and on a tablet terminal for patients to use while waiting in the clinic. Using the tablet terminal, a doctor and patient may check for improvement of symptoms together.

scholarly journals Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Breanna Wright ◽  
Alyse Lennox ◽  
Mark L. Graber ◽  
Peter Bragge
Keyword(s):  
Diagnostic Test ◽  
Point Of Care ◽  
Patient Perspectives ◽  
Audit And Feedback ◽  
Rapid Review ◽  
Test Results ◽  
Multiple Perspectives ◽  
Communication Breakdown ◽  
Closing The Loop ◽  
Test Result

Abstract Background Communication failures involving test results contribute to issues of patient harm and sentinel events. This article aims to synthesise review evidence, practice insights and patient perspectives addressing problems encountered in the communication of diagnostic test results. Methods The rapid review identified ten systematic reviews and four narrative reviews. Five practitioner interviews identified insights into interventions and implementation, and a citizen panel with 15 participants explored the patient viewpoint. Results The rapid review provided support for the role of technology to ensure effective communication; behavioural interventions such as audit and feedback could be effective in changing clinician behaviour; and point-of-care tests (bedside testing) eliminate the communication breakdown problem altogether. The practice interviews highlighted transparency, and clarifying the lines of responsibility as central to improving test result communication. Enabling better information sharing, implementing adequate planning and utilising technology were also identified in the practice interviews as viable strategies to improve test result communication. The citizen panel highlighted technology as critical to improving communication of test results to both health professionals and patients. Patients also highlighted the importance of having different ways of accessing test results, which is particularly pertinent when ensuring suitability for vulnerable populations. Conclusions This paper draws together multiple perspectives on the problem of failures in diagnostic test results communication to inform appropriate interventions. Across the three studies, technology was identified as the most feasible option for closing the loop on test result communication. However, the importance of clear, consistent communication and more streamlined processes were also key elements that emerged. Review registration The protocol for the rapid review was registered with PROSPERO CRD42018093316.

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