title: Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey.
abstract: BACKGROUND
  Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system.
  
  
  METHODS
  Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use.
  
  
  RESULTS
  Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications.
  
  
  CONCLUSIONS
  Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.
authors.affiliation: Department of Medicine, Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Baylor College of Medicine, Houston, Texas 77030, USA. hardeeps@bcm.edu
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.forename: Christiane
authors.initials: C
authors.lastname: Spitzmueller
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Mona K
authors.initials: MK
authors.lastname: Sawhney
authors.forename: Michael W
authors.initials: MW
authors.lastname: Smith
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Murphy
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.forename: Archana
authors.initials: A
authors.lastname: Laxmisan
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
mesh_terms: D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D057286:Electronic Health Records; D006801:Humans; D016347:Medical Records Systems, Computerized; D058007:Physicians, Primary Care; D011320:Primary Health Care; D014481:United States