title: Test result management in global health settings.
abstract: Across the globe, the ways in which patients' test results are managed are as varied as the many different types of healthcare systems that manage these data. The outcomes, however, are often not too dissimilar: too many clinically significant test results fall through the cracks. The consequences of not following up test results in a timely manner are serious and often devastating to patients: diagnoses are delayed, treatments are not initiated or altered in time, and diseases progress. In resource-poor settings, test results too commonly get filed away within the paper chart in ways that isolate them and prevent passage to future providers caring for a patient. To make matters worse, the onus to act upon these test results often rests on patients who need to return to the clinic within a specified timeframe in order to obtain their results but who may not have the means or are too ill to do so. Even in more developed healthcare settings that use electronic records, clinical data residing in the electronic medical record (EMR) are often stubbornly "static"-key pieces of clinical information are frequently not recognized, retrieved, or shared easily. In this way, EMRs are not unlike paper record systems, and therefore, EMRs alone will not solve this problem. To illustrate this problem, consider the case of a patient newly diagnosed with HIV in 3 different healthcare delivery settings.
authors.affiliation: Daniel Palazuelos, MD, MPH, is an associate physician on the BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital; an assistant program director for the Global Health Equity (GHE) Residency in the Division of GHE, Brigham and Women's Hospital; the director of the Community Health Worker Quality Improvement Task Force at Partners in Health; and an instructor at Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palazuelos
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Payne
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Dalal
keywords: Electronic medical records; community health workers; global health; integrated voice response; mobile devices; short messaging service; test results; text messages