title: Effectiveness of an electronic health record-based intervention to improve follow-up of abnormal pathology results: a retrospective record analysis.
abstract: OBJECTIVE
  On March 11, 2009, the Veterans Health Administration (VA) implemented an electronic health record (EHR)-based intervention that required all pathology results to be transmitted to ordering providers by mandatory automated notifications. We examined the impact of this intervention on improving follow-up of abnormal outpatient pathology results.
  
  
  METHODS
  We extracted pathology reports from the EHR of 2 VA sites. From 16,738 preintervention and 17,305 postintervention reports between 09/01/2008 and 09/30/2009, we randomly selected about 5% and evaluated follow-up outcomes using a standardized chart review instrument. Documented responses to the alerted report (eg, ordering follow-up tests or referrals, notifying patients, and prescribing/changing treatment) were recorded.
  
  
  METHODS
  Primary outcome measures included proportion of timely follow-up responses (within 30 d) and median time to direct response for abnormal reports.
  
  
  RESULTS
  Of 816 preintervention and 798 postintervention reports reviewed, 666 (81.6%) and 688 (86.2%) were abnormal. Overall, there was no apparent intervention effect on timely follow-up (69% vs. 67.1%; P=0.4) or median time to direct response (8 vs. 8 d; P=0.7). However, logistic regression uncovered a significant intervention effect (preintervention odds ratio, 0.7; 95% confidence interval, 0.5-1.0) after accounting for site-specific differences in follow-up, with a lower likelihood of timely follow-up at one site (odds ratio, 0.4; 95% confidence interval, 0.2-0.7).
  
  
  CONCLUSIONS
  An electronic intervention to improve test result follow-up at 2 VA institutions using the same EHR was found effective only after accounting for certain local contextual factors. Aggregating the effect of EHR interventions across different institutions and EHRs without controlling for contextual factors might underestimate their potential benefits.
authors.affiliation: Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. laxmisan@bcm.edu
authors.forename: Archana
authors.initials: A
authors.lastname: Laxmisan
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pietz
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Krishnan
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D010336:Pathology; D017010:Reminder Systems; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*