Understanding the management of electronic test result notifications in the outpatient setting
Open accessAbstract
BACKGROUND: Notifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts. METHODS: We conducted a qualitative study consisting of six 6-8 member focus groups (N = 44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow. RESULTS: Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification. CONCLUSION: Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.
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The experimental design was based on previous findings that attending physicians use the EHR to manage approximately 57 test results per day over multiple interactions.
“The experimental design was based on previous findings that attending physicians use the EHR to manage approximately 57 test results per day over multiple interactions.22,23”
From Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians (2019) · cites this paper as [23]
The Results section (“Number of Alerts Received,” page unavailable) supports that providers manage test-result alerts in the EHR amid a heavy alert workload. But its quoted estimate is 60–70 alerts per day, including notifications other than test results; it does not establish approximately 57 test results per day for attending physicians or specify multiple interactions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSome key remaining barriers to effective management of test results are suboptimal usability of existing EHR interfaces and the high volume of abnormal test result alerts, especially less-critical alerts that produce clutter and distract from the important ones.
“Some key remaining barriers to effective management of test results are suboptimal usability of existing EHR interfaces and the high volume of abnormal test result alerts, especially less-critical alerts that produce clutter and distract from the important ones.22,23”
From Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians (2019) · cites this paper as [23]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn previous work, the sociotechnical model was applicable in specific clinical contexts such as test results and referral communication.
“For instance, in our previous work, we found this sociotechnical model applicable in specific clinical contexts (eg, test results and referral communication), 43 -48”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [45]
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- Authors
- Hysong, S. J., Sawhney, M. K., Wilson, L., Sittig, D. F., Esquivel, A., Singh, S., & Singh, H.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Memorial Hermann (US)
- Baylor St. Luke's Medical Center (US)
- Louis Stokes Cleveland VA Medical Center (US)
- Corresponding author
- Hysong, Sylvia J
- Venue
- BMC Medical Informatics and Decision Making
- Published
- 2011-04-12
- Volume
- 11
- Issue
- 1
- Pages
- 22-22
- ISSN
- 1472-6947 (ISSN-L)
- PMC
- PMC3100236
- OpenAlex
- W2019161420
- Cited by
- 68
- References
- 36
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 11 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 5 · 2012: 6
- FWCI
- 8.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs (CD2-07-0181)
- National Institutes of Health (HFP90-020)
- Agency for Healthcare Research and Quality (T32HS017586)
- National Cancer Institute (K23CA125585)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- electronic alerts, electronic health records, outpatient care, clinical workflow redesign, primary care providers, Veterans Affairs health care, barriers and facilitators
- MeSH terms
- Communication, Continuity of Patient Care, Humans, Management Information Systems, Outpatients, Veterans, Reminder Systems, Electronic Health Records
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