Significant improvements to current EHR technology are necessary to eliminate social and technical obstacles preventing practitioners and physicians from interacting with test results effectively, according to new research published in JAMIA. As Singh et al. note, the failure to respond to abnormal test results represents a significant threat to patient safety, and despite efforts to incorporate notification capabilities into EHR systems, previous studies have shown that incidences of failed follow-up to abnormal results still persist.
So what is lacking in current EHR technology to correct these failures? While Stage 2 Meaningful Use targets structured laboratory result reporting, the authors observe that “little is known about how to optimize EHR-based test result management.” According to Singh et al., various forces are responsible for limiting the effectiveness of notifications, which most EHR systems manage using email. On the one hand, there is the level of noise in the provider’s inbox where notifications compete for attention against “less important data.” On the other, there is an administrative quagmire that prevents providers from understanding which provider is responsible for conducting the follow-up.
The study comprises feedback from nearly 2,600 primary care physicians (PCPs) between June and November 2010 working in a Department of Veterans Affairs (VA) healthcare facility and using the agency’s EHR, the Computerized Patient Record System (CPRS), which is equipped with a “View Alert” notification system for communicating test results among other clinical data.
Here’s what the web-based survey revealed about the factors influencing how test results and notifications are handled:
Training on the notification system lags behind knowledge, experience: Although most of the respondents reported having used the VA EHR for two or more years, less than half (45.7%) indicated that they had received proper training on the notification system, with a small portion (13.7%) stating that they had partook of refresher training. Despite the lack of training, a large majority believed they were sufficiently knowledgeable (74.4%) and proficient (81.8%) to operate the View Alert system. What’s more, nearly half (46.6%) indicated that they had prior experience with an EHR system before working with the VA CPRS, which a majority (55%) identified as superior to their previous system.
Notification systems underused, lack features for notifying patients: As many as 55.5% of respondents believed the VA EHR lacked convenient features for notifying patients of test results. Moreover, advanced features intended to improve the management of alerts were underused by PCPs. Whereas less than two-thirds (62.7%) reported using a basic sort feature for monitoring and managing alerts, nearly half (37.9%) that amount made use of advanced features for adjusting how they receive alerts, with the majority relying on system defaults for deeming the importance of notifications. Those with sufficient support resources (37.9%) relied on staff to notify patients. Others waited until the patient’s next visit to notify the patient of normal (46.1%) and abnormal (20.1%) results
Physicians are on high alert, need additional time to manage notifications: A vast majority of PCPs (80.2%) report being overwhelmed by too alerts, with most (69.9%) admitting that the number of alerts is beyond their ability to manage them. The volume of alerts and the time they require have led to longer days and weekend hours for most providers (85.6%).
Physicians want more control over, better access to alerts: Most respondents identified the ability to set their reminders (83.4%) and send messages to other providers outside of the View Alert system (70.5%) as the best means for improving the software pertaining to notifications. Another area for improvement identified by a large number of PCPs dealt with tracking of alerts, most importantly being able to move from current to previous windows via a back button (83.9%), retrieve deleted alerts (78.6%), and prevent high priority alerts from being removed unless actively deleted (73.9%).
Given that future stages of meaningful use will require providers to exchange information on a large scale, the increase in the amount of information exchanged and the responses from provides that it requires runs the risk of increasing threats to patient safety if methods for managing notifications and alerts effectively are not developed in time.