Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Project Final Report (PDF, 364.79 KB) Disclaimer
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Disclaimer
Disclaimer details
Project Details -
Completed
-
Grant NumberR01 HS022087
-
AHRQ Funded Amount$1,992,585
-
Principal Investigator(s)
-
Organization
-
LocationHoustonTexas
-
Project Dates09/01/2013 - 07/31/2018
-
Population
-
Type of Care
-
Health Care Theme
A significant number of patients with abnormal test results “fall through the cracks” of the healthcare system and experience delays in diagnosis and treatment. Although electronic health records (EHRs) expedite the communication of abnormal test results, they do not guarantee the prompt followup that is required for timely care. The researchers’ previous work indicated that followup for abnormal tests is influenced by a multitude of technological and non-technological factors such as user behaviors, workflow, information load, policies and procedures, and training. Improving test result followup requires a better understanding of how followup processes fit within the complex “socio-technical” context of EHR-enabled healthcare.
Guided by a human factors-based conceptual model, this project conducted cognitive task-analysis among providers who ordered tests at four clinical sites. Structured observations, brief surveys, and key informant interviews were used to understand result followup in EHR-based systems. Finally, the team conducted a socio-technical risk assessment of factors that impact EHR-based test result followup.
The specific aims of the project were as follows:
- Understand the cognitive factors that affect the task of test result followup by individuals and teams in EHR-based health systems.
- Understand the nature of clinical work related to EHR-based test result followup in the sociotechnical context of health information technology (IT)-enabled outpatient settings.
- Conduct prospective risk assessments to characterize socio-technical contextual factors that present risks to appropriateness and timeliness of abnormal test result followup in EHR-enabled healthcare systems.
The project team found that a broad range of socio-technical factors may lead to delays in abnormal test result followup. Barriers to test followup were identified throughout the testing process and most frequently occur at steps involving health IT, including usability of the EHR by clinicians, and communication interfaces between the EHR and diagnostic services. Personnel training, workflow optimization and standardization, and improved electronic communication between clinics and diagnostic services were identified as facilitators for test followup. The researchers concluded that in clinical workflow there is a need for dedicated personnel for lab results followup. In EHRs, there is a need for decreasing alert load, implementing EHR designs to facilitate followup, and improving patient engagement.
Citation:
Murphy DR, Satterly T, Rogith D, Sittig DF, Singh H. Barriers and facilitators impacting reliability of the electronic health record-facilitated total testing process. Int J Med Inform. 2019 Jul;127:102-108. doi:10.1016/j.ijmedinf.2019.04.004. Epub 2019 Apr 8. PMID: 31128821.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Interview, Qualitative
Citation:
Murphy DR, Satterly T, Giardina TD, Sittig DF, Singh H. Practicing clinicians' recommendations to reduce burden from the electronic health record inbox: a mixed-methods study. J Gen Intern Med. 2019 Sep;34(9):1825-1832. doi:
10.1007/s11606-019-05112-5. Epub 2019 Jul 10. PMID: 31292905.
10.1007/s11606-019-05112-5. Epub 2019 Jul 10. PMID: 31292905.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Interview, Quantitative, Survey
Population:
Physician
Citation:
Berenson R, Singh H. Payment innovations to improve diagnostic accuracy and reduce diagnostic error. Health Aff (Millwood). 2018 Nov;37(11):1828-1835. PMID: 30395510.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Citation:
Giardina TD, Haskell H, Menon S, et al. Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety. Health Aff (Millwood). 2018 Nov;37(11):1821-1827. PMID: 30395513.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Mixed Methods, Survey
Population:
Patient
Citation:
Medford-Davis LN, Singh H, et al. Diagnostic Decision-Making in the Emergency Department. Pediatr Clin North Am. 2018 Dec;65(6):1097-1105. PMID: 30446050.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Population:
Children
Citation:
Singh H. Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings - Final Report. (Prepared by Baylor College of Medicine under Grant No. R01 HS022087). Rockville, MD: Agency for Healthcare Research and Quality, 2018.
Link:
PDF (364.79 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Report
Research Method:
Interview, Mixed Methods, Survey, Think Aloud Protocol/Cognitive Task Analysis
Population:
Clinical Staff/Clinician
Citation:
Giardina T, Baldwin J, Nystrom D, et al. Patient perceptions of receiving test results via online portals: a mixed-methods study. J Am Med Inform Assoc 2017 Dec 12. PMID: 29240899.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Structured/Semi-Structured Interview
Technology:
Patient Portal
Citation:
Singh H. Improving diagnostic safety in primary care by unlocking digital data. Jt Comm J Qual Patient Saf 2017 Jan;43(1):29-31. PMID: 28334582.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Review
Population:
Researcher
Citation:
Pfoh ER, Engineer L, Singh H, et al. Informing the design of a new pragmatic registry to stimulate near miss reporting in ambulatory care. J Patient Saf 2017 Feb 28. doi: 10.1097/PTS.0000000000000317. PMID: 28248748.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Systematic Review
Citation:
Meyer AND, Murphy DR, Al-Mutairi A, et al. Electronic detection of delayed test result follow-up in patients with hypothyroidism. J Gen Intern Med 2017 Jul;32(7):753-9. PMID: 28138875.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Chart Review, Quantitative, Retrospective
Citation:
Menon S, Singh H, Giardina TD, et al. Safety huddles to proactively identify and address electronic health record safety. J Am Med Inform Assoc 2017 Mar 1;24(2):261-7. PMID: 28031286.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Qualitative
Population:
Administrator, Clinical Staff/Clinician, IT Staff
Citation:
Davalos MC, Samuels K, Meyer AN, et al. Finding diagnostic errors in children admitted to the PICU. Pediatr Crit Care Med 2017 Mar;18(3):265-71. PMID: 28125548.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Chart Review, Quantitative
Population:
Adolescents and Young Adults, Children, Infants
Citation:
Russo E, Sittig DF, Murphy DR, Singh H. Challenges in patient safety improvement research in the era of electronic health records. Healthc (Amst) 2016 Dec;4(4):285-90. PMID: 27473472.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Citation:
Menon S, Murphy DR, Singh H, et al. Workarounds and test results follow-up in electronic health record-based primary care. Appl Clin Inform 2016 Jun 22;7(2):543-59. PMID: 27437060.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Cross-Sectional (Prevalence) Study, Mixed Methods
Population:
Physician
Citation:
Murphy DR, Meyer AND, Russo E, et al. The burden of inbox notifications in commercial electronic health records. JAMA Intern Med 2016 Apr;176(4):559–60. PMID: 26974737.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Mixed Methods
Citation:
Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer 2015 Mar 31;112 Suppl 1:S84-91. PMID: 25734393.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Review
Citation:
Sittig DF, Murphy DR, Smith MW, et al. Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems. J Am Med Inform Assoc 2015;22(4):900–4. PMID: 25792704.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Qualitative
Citation:
Al-Mutairi A, Meyer AND, Chang P, et al. Lack of timely follow-up of abnormal imaging results and radiologists’ recommendations. J Am Coll Radiol 2015;12(4):385–9. PMID: 25582812.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Quantitative, Retrospective
Citation:
Callen J, Giardina TD, Singh H, et al. Emergency physicians' views of direct notification of laboratory and radiology results to patients using the Internet: a multisite survey. J Med Internet Res 2015 Mar 4;17(3):e60. PMID: 25739322.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Cross-Sectional (Prevalence) Study, Quantitative, Survey
Technology:
Patient Portal
Population:
Physician
Citation:
Vartian CV, Singh H, Russo E, et al. Development and field testing of a self-assessment guide for computer-based provider order entry. J Healthc Manag 2014 Sep-Oct;59(5):338-52. PMID: 25647953.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication
Research Method:
Interview, Mixed Methods
Technology:
Computerized Provider Order Entry System
Population:
C-Suite Officer
Citation:
Singh H. Editorial: Helping health care organizations to define diagnostic errors as missed opportunities in diagnosis. Jt Comm J Qual Patient Saf 2014;40(3):99-101.
Principal Investigator:
Singh, Hardeep
Project Name:
Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings
Document Type:
Journal Publication, Editorial
Disclaimer
Disclaimer details