Provider management strategies of abnormal test result alerts: a cognitive task analysis
Open accessAbstract
OBJECTIVE: Electronic medical records (EMRs) facilitate abnormal test result communication through "alert" notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results. DESIGN: 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens. RESULTS: Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts. CONCLUSION: Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results.
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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 [22]
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.
“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 [22]
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- Authors
- Hysong, S. J., Sawhney, M. K., Wilson, L., Sittig, D. F., Espadas, D., Davis, T., & Singh, H.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Memorial Hermann (US)
- Corresponding author
- Hysong, S. J
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-01-01
- Volume
- 17
- Issue
- 1
- Pages
- 71-77
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC2995633
- OpenAlex
- W2143215537
- Cited by
- 65
- References
- 55
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 6 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 12 · 2013: 5 · 2012: 4
- FWCI
- 10.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (K23CA125585)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- clinical decision support alerts, electronic health records, primary care providers, cognitive task analysis, clinical judgment, Veterans Affairs hospitals
- MeSH terms
- Computer User Training, Continuity of Patient Care, Diagnostic Imaging, Female, Humans, Male, Practice Patterns, Physicians', Primary Health Care, Task Performance and Analysis, Texas, Veterans, Reminder Systems, Electronic Health Records
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