Emergency physicians' views of direct notification of laboratory and radiology results to patients using the Internet: a multisite survey.
BACKGROUND
Patients are increasingly using the Internet to communicate with health care providers and access general and personal health information. Missed test results have been identified as a critical safety issue with studies showing up to 75% of tests for emergency department (ED) patients not being followed-up. One strategy that could reduce the likelihood of important results being missed is for ED patients to have direct access to their test results. This could be achieved electronically using a patient portal tied to the hospital's electronic medical record or accessed from the relevant laboratory information system. Patients have expressed interest in accessing test results directly, but there have been no reported studies on emergency physicians' opinions.


OBJECTIVE
The aim was to explore emergency physicians' current practices of test result notification and attitudes to direct patient notification of clinically significant abnormal and normal test results.


METHODS
A cross-sectional survey was self-administered by senior emergency physicians (site A: n=50; site B: n=39) at 2 large public metropolitan teaching hospitals in Australia. Outcome measures included current practices for notification of results (timing, methods, and responsibilities) and concerns with direct notification.


RESULTS
The response rate was 69% (61/89). More than half of the emergency physicians (54%, 33/61) were uncomfortable with patients receiving direct notification of abnormal test results. A similar proportion (57%, 35/61) was comfortable with direct notification of normal test results. Physicians were more likely to agree with direct notification of normal test results if they believed it would reduce their workload (OR 5.72, 95% CI 1.14-39.76). Main concerns were that patients could be anxious (85%, 52/61), confused (92%, 56/61), and lacking in the necessary expertise to interpret their results (90%, 55/61).


CONCLUSIONS
Although patients' direct access to test results could serve as a safety net reducing the likelihood of abnormal results being missed, emergency physicians' concerns need further exploration: which results are suitable and the timing and method of direct release to patients. Methods of access, including secure Web-based patient portals with drill-down facilities providing test descriptions and result interpretations, or laboratories sending results directly to patients, need evaluation to ensure patient safety is not compromised and the processes fit with ED clinician and laboratory work practices and patient needs.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. joanne.callen@mq.edu.au.
Joanne
http://orcid.org/0000-0002-4271-7558
J
Callen
Traber Davis
http://orcid.org/0000-0002-9184-6524
TD
Giardina
Hardeep
http://orcid.org/0000-0002-4419-8974
H
Singh
Ling
http://orcid.org/0000-0002-1642-142X
L
Li
Richard
http://orcid.org/0000-0003-4140-408X
R
Paoloni
Andrew
http://orcid.org/0000-0002-7619-3668
A
Georgiou
William B
http://orcid.org/0000-0002-0567-5168
WB
Runciman
Johanna I
http://orcid.org/0000-0003-1083-8192
JI
Westbrook
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D019411:Clinical Laboratory Techniques; D003430:Cross-Sectional Studies; D003625:Data Collection; D030881:Disclosure; D057286:Electronic Health Records; D004635:Emergency Medicine; D006784:Hospitals, Teaching; D006801:Humans; D020407:Internet; D008875:Middle Aged; D033283:Patient Access to Records; D010820:Physicians / Q000523:psychology; D011871:Radiology; D016526:Workload
Internet; diagnostic tests; electronic health records; emergency care; patient empowerment; patient safety; radiology