scholarly journals The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study

10.2196/13791 ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. e13791 ◽  
Author(s):  
Brody Foster ◽  
Matthew David Krasowski
Keyword(s):  
Retrospective Study ◽  
Electronic Health Record ◽  
Diagnostic Test ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Record ◽  
Patient Portal ◽  
Test Results ◽  
Emergency Patients ◽  
Academic Medical

scholarly journals The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study (Preprint)

2019 ◽  
Author(s):  
Brody Foster ◽  
Matthew David Krasowski
Keyword(s):  
Diagnostic Test ◽  
Laboratory Tests ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Portal ◽  
Test Results ◽  
Patient Portals ◽  
Radiology Reports ◽  
Academic Medical ◽  
Laboratory Results

BACKGROUND Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients. OBJECTIVE The study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race. METHODS This institutional review board–approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account. RESULTS Overall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal. CONCLUSIONS The data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients.

scholarly journals Variation in results release and patient portal access to diagnostic test results at an academic medical center

2017 ◽  
Vol 8 (1) ◽  
pp. 45 ◽  
Author(s):  
MatthewD Krasowski ◽  
CalebV Grieme ◽  
Brian Cassady ◽  
NicholasR Dreyer ◽  
KarolynA Wanat ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Portal ◽  
Test Results ◽  
Academic Medical

Moving Radiology Workflow to the Electronic Health Record: Quantitative and Qualitative Experience From a Large Academic Medical Center

2020 ◽  
Vol 27 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Benjamin Wildman-Tobriner ◽  
Matthew P. Thorpe ◽  
Nicholas Said ◽  
Wendy L. Ehieli ◽  
Christopher J. Roth ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Radiology Workflow ◽  
Health Record ◽  
Academic Medical ◽  
Electronic Health

Abstract 15537: An Electronic Health Record Intervention to Optimize Utilization of Transthoracic Echocardiography: Opportunity for Cost Savings in the Era of Value Based-care

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jason Castaneda ◽  
corey rearick ◽  
Joseph Weber ◽  
Eve Edstrom ◽  
Kimisha Cassidy ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Transthoracic Echocardiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Health Record ◽  
Post Intervention ◽  
Academic Medical ◽  
Electronic Health ◽  
Value Based Care

Introduction: In the current value-based era, targeting diagnostic resources and minimizing unnecessary testing is of paramount importance. Transthoracic echocardiography (TTE) is a common and costly test, and available Appropriate Use Criteria (AUC) guide optimal utilization. Limited TTE (L-TTE) shortens sonographer time, lowers cost and may be ideal for repeat TTEs (R-TTE) with a focused indication. However, many clinicians are unfamiliar with the AUC and opportunities for L-TTE. We prospectively tested an Electronic Health Record (EHR)-based intervention aimed at optimizing TTE utilization in a large academic medical center. Methods: TTE utilization at the University of Chicago Medicine was assessed over a 6-month period and complete TTE (C-TTE), L-TTE and R-TTE (TTE repeated within 6 months) were recorded. An EHR-based intervention was then implemented and TTE utilization was assessed over the ensuing 8 weeks. The intervention included presenting new descriptive L-TTE options (i.e. “Limited TTE: EF or Effusion Only”) when any “echo” was searched in the EHR order panel, an alert to prior TTEs (i.e. date & LVEF) and a link to AUC-based guidance for TTE ordering. Educational materials were also distributed to frequent TTE ordering providers. Results: Among 9121 TTEs (53% inpatient) pre-intervention , 11% (n=1002) were L-TTEs and 25% (n=2320) were R-TTEs. There were more L-TTEs and R-TTEs in pre-intervention inpatients compared to outpatients (L-TTE 14% vs 7%, p<0.0001, R-TTE 33% vs 17%, p<0.0001). Post-intervention (2879 TTEs, 53% inpatient), R-TTEs significantly decreased (22.6% vs 25.4%, p=0.0019) and L-TTEs significantly increased (14% vs 11%, p<0.0001) compared to pre-intervention, with inpatient TTEs most impacted (R-TTE 28% vs 33%, p=0.0016, L-TTE 19% vs 14%, p<0.001). The intervention’s greatest impact was to markedly increase L-TTEs among inpatient R-TTEs (44% vs 35%, p=0.0002). Conclusions: Despite AUC discouraging frequent repeat TTEs, R-TTEs are common in an academic medical center and utilization of L-TTE is rare. An EHR-based intervention with prior TTE alerts and descriptive L-TTE options increases L-TTEs and reduces R-TTEs. Further study is warranted to describe the full clinical and financial impact of this intervention.

Clinician perspectives on preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 54-54
Author(s):  
Kelsey S. Lau-Min ◽  
Lisa A. Varughese ◽  
Maria N. Nelson ◽  
Christine Cambareri ◽  
Nandi J. Reddy ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Structured Interview ◽  
Routine Practice ◽  
Health Record ◽  
Theory Approach ◽  
Test Results ◽  
Gastrointestinal Malignancies ◽  
Electronic Health

54 Background: Pharmacogenetic (PGx) testing for germline variants in the DPYD and UGT1A1 genes can be used to guide fluoropyrimidine and irinotecan dosing, respectively. Despite the known association between PGx variants and chemotherapy toxicity, preemptive testing prior to chemotherapy initiation is rarely performed in routine practice. Methods: We conducted a multi-site mixed-methods study to understand clinician attitudes toward PGx testing and to identify facilitators and barriers to using preemptive testing to guide chemotherapy dosing in patients with gastrointestinal malignancies. Each participant completed a demographic survey and semi-structured interview informed by the Consolidated Framework for Implementation Research. Interviews were analyzed using a modified grounded theory approach. Results: A total of 16 medical oncologists and 9 oncology pharmacists from one academic medical center and two community hospitals participated. Fifteen (60%) participants reported feeling comfortable or very comfortable with interpreting PGx test results. While clinicians expressed generally favorable attitudes toward PGx testing, many were hesitant to use it to preemptively guide chemotherapy dosing due to a perceived lack of evidence for this practice. They cited a lack of consensus chemotherapy dosing recommendations in response to PGx test results, as well as concerns about decreased drug efficacy, especially in patients treated with curative intent. Additional barriers included 1) a low prevalence of actionable PGx variants; 2) lengthy PGx test turnaround time; 3) concerns about testing costs and lack of insurance coverage; and 4) burdensome integration of PGx testing into clinical workflows. The electronic health record emerged as a potential tool for the unobtrusive integration of PGx testing into clinical practice–suggested applications included default PGx test orders for eligible patients, discrete reporting of PGx variant results, and clinical decision support to guide subsequent chemotherapy dosing. Conclusions: Successful adoption of preemptive PGx-guided chemotherapy dosing in patients with gastrointestinal malignancies will require a multi-level effort to demonstrate clinical effectiveness while addressing the contextual factors identified in this study. The electronic health record should be explored as a tool to integrate PGx testing into routine practice.

Leveraging Structural Changes in an Electronic Health Record Tool to Standardize Written Handoff

2018 ◽  
Vol 34 (4) ◽  
pp. 354-359 ◽  
Author(s):  
Jillian Zavodnick ◽  
Rebecca Jaffe ◽  
Marc Altshuler ◽  
Scott Cowan ◽  
Alexis Wickersham ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Structural Changes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Record ◽  
Patient Handoff ◽  
Academic Medical ◽  
Effective Training ◽  
Before And After ◽  
Electronic Health

Miscommunications during patient handoff can lead to harm. The I-PASS bundle has been shown to improve safety outcomes. Although effective training reliably improves verbal handoffs, research has demonstrated a lack of effect on written handoffs. The objective was to compare written handoff before and after integration of a standardized electronic health record (EHR) tool. Interns at a large urban academic medical center underwent I-PASS handoff training. The EHR handoff tool was then revised to prompt the I-PASS components. Handoff documents were obtained before and after the intervention. More handoffs included Illness Severity (33% to 59%, P < .001) and Action List (65% to 83%, P = .005) after the intervention. There was no change in handoffs with miscommunications (12.5% to 10%, P = .566) or omissions (8% to 11%, P = .447). Handoffs including tangential or unrelated information decreased (20% to 4%, P = .001). A written handoff tool can reinforce the effect of training and increase adherence to I-PASS.

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