title: Provider management strategies of abnormal test result alerts: a cognitive task analysis.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Houston VA HSR&D Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA. hysong@bcm.edu
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.forename: Mona K
authors.initials: MK
authors.lastname: Sawhney
authors.forename: Lindsay
authors.initials: L
authors.lastname: Wilson
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.forename: Traber
authors.initials: T
authors.lastname: Davis
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D003200:Computer User Training; D003266:Continuity of Patient Care; D003952:Diagnostic Imaging; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017010:Reminder Systems; D013647:Task Performance and Analysis; D013781:Texas; D014728:Veterans