Presenters discussed their research findings around how clinical work is accomplished using electronic health records and how to optimally design key functionalities such as prevention alerts and abnormal results followup.
Enhancing Providers' Ability to Follow Up on Abnormal Test Results
Project Final Report (PDF, 632.73 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.
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Project Details -
Completed
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Grant NumberR21 HS024062
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AHRQ Funded Amount$298,382
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Principal Investigator(s)
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Organization
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LocationChapel HillNorth Carolina
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Project Dates08/01/2015 - 07/31/2017
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Care Setting
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Medical Condition
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Type of Care
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Health Care Theme
Mammograms and Papanicolaou (Pap) smears can improve patient outcomes for breast and cervical cancer. Appropriate and timely follow up of abnormal results must occur to achieve the full benefit of cancer screening; however, follow up is frequently inadequate. Electronic health records (EHRs) with alerts and reminders for abnormal results can improve timely follow up of abnormal test results; nonetheless, even when providers acknowledge abnormal results, some patients still do not receive timely follow up. The problem is a multifaceted safety issue that occurs within the complex “sociotechnical” system of healthcare, involving complex interactions between providers, patients, the EHR, workflows, and organizational factors. Additionally, cross-coverage scenarios in which providers receive abnormal results for other providers’ patients increase the likelihood that follow ups are not completed.
This project conducted a randomized controlled trial to assess provider workload and performance during abnormal test results-based tasks in a standard EHR environment versus an enhanced EHR environment, under regular-coverage and cross-coverage scenarios. The enhanced EHR environment had a “result tracking” function that allowed providers to closely monitor critical abnormal test results and was not available in the standard EHR environment.
The specific aim of this project was as follows:
- Subjectively and objectively assess provider mental workload and performance during abnormal test results-based tasks in a baseline EHR environment versus an enhanced EHR environment with results tracking functionality under regular-coverage and cross-coverage scenarios.
When providers were presented with a high-volume of abnormal test results, task demands, providers’ perception of workload, and time to complete the scenarios increased significantly. Cross-covering providers experienced twice the volume of alerts of compared to the non-cross-covering providers and their clinical performance degraded when tracking and following up on patients with planned diagnostic evaluation. The enhanced EHR environment with results tracking functionality resulted in significant improvements in clinical performance and physiological workload. Overall, fatigue levels affected performance, especially for participants indicating low or high fatigue levels.
Results suggest that longitudinal monitoring and tracking of abnormal test results and patient status can help ensure appropriate follow up of abnormal test results. Additional research is needed to quantify effects of innovative functionality and usability features for ensuring appropriate acknowledgment and follow up of abnormal test results.
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Citation:
Mazur LM, Mosaly PR, Moore C, Marks L. Association of the usability of electronic health records with cognitive workload and performance levels among physicians. JAMA Netw Open. 2019 Apr 5;2(4):e191709. doi:
10.1001/jamanetworkopen.2019.1709. PMID: 30951160.
10.1001/jamanetworkopen.2019.1709. PMID: 30951160.
Principal Investigator:
Mazur, Lukasz
Document Type:
Journal Publication
Research Method:
Quantitative, Randomized Controlled Trial (RCT), Usability Assessment
Population:
Physician
Citation:
Mosaly P, Mazur LM, Fei Y, et al. Relating task demand, mental effort and task difficulty with physicians’ performance during interactions with electronic health records (EHRs). Int J Hum Comput Interact 2018;34(5):
467-75, DOI: 10.1080/10447318.2017.1365459
467-75, DOI: 10.1080/10447318.2017.1365459
Principal Investigator:
Mazur, Lukasz
Document Type:
Journal Publication
Research Method:
Observational Study, Quantitative
Population:
Physician
Citation:
Mosaly PR, Mazur LM, Marks L. Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load. Ergonomics.2017 Feb 15:1-7. PMID: 28140793.
Principal Investigator:
Mazur, Lukasz
Document Type:
Journal Publication
Research Method:
Quantitative
Population:
Physician
Citation:
Mazur L. Enhancing Providers' Ability to Follow-up on Abnormal Test Results - Final Report. (Prepared by the University of North Carolina Chapel Hill under Grant No. R21 HS024062). Rockville, MD: Agency for Healthcare Research and Quality, 2017.
Link:
PDF (632.73 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:
Mazur, Lukasz
Document Type:
Report
Research Method:
Quantitative, Randomized Controlled Trial (RCT)
Citation:
Mazur LM, Mosaly PR, Moore C, et al. Toward a better understanding of task demands, workload, and performance during physician-computer interactions. J Am Med Inform Assoc 2016 Mov;23(6):1113-20. PMID: 27026617.
Principal Investigator:
Mazur, Lukasz
Document Type:
Journal Publication
Research Method:
Observational Study, Quantitative, Time and Motion
Population:
Physician
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