title: Understanding the management of electronic test result notifications in the outpatient setting.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Houston VA Health Sciences Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.sylvia.hysong@va.gov
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.forename: Mona K
authors.initials: MK
authors.lastname: Sawhney
authors.forename: Lindsey
authors.initials: L
authors.lastname: Wilson
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Adol
authors.initials: A
authors.lastname: Esquivel
authors.forename: Simran
authors.initials: S
authors.lastname: Singh
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D006801:Humans; D008331:Management Information Systems; D010045:Outpatients; D017010:Reminder Systems; D014728:Veterans