Houston VA HSR&D Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine , Houston, Texas.
Appl Clin Inform. 2013 Jul 31;4(3):359-75. doi: 10.4338/ACI-2013-04-RA-0019. eCollection 2013.
Abnormal test results do not always receive timely follow-up, even when providers are notified through electronic health record (EHR)-based alerts. High workload, alert fatigue, and other demands on attention disrupt a provider's prospective memory for tasks required to initiate follow-up. Thus, EHR-based tracking and reminding functionalities are needed to improve follow-up.
The purpose of this study was to develop a decision-support software prototype enabling individual and system-wide tracking of abnormal test result alerts lacking follow-up, and to conduct formative evaluations, including usability testing.
We developed a working prototype software system, the Alert Watch And Response Engine (AWARE), to detect abnormal test result alerts lacking documented follow-up, and to present context-specific reminders to providers. Development and testing took place within the VA's EHR and focused on four cancer-related abnormal test results. Design concepts emphasized mitigating the effects of high workload and alert fatigue while being minimally intrusive. We conducted a multifaceted formative evaluation of the software, addressing fit within the larger socio-technical system. Evaluations included usability testing with the prototype and interview questions about organizational and workflow factors. Participants included 23 physicians, 9 clinical information technology specialists, and 8 quality/safety managers.
Evaluation results indicated that our software prototype fit within the technical environment and clinical workflow, and physicians were able to use it successfully. Quality/safety managers reported that the tool would be useful in future quality assurance activities to detect patients who lack documented follow-up. Additionally, we successfully installed the software on the local facility's "test" EHR system, thus demonstrating technical compatibility.
To address the factors involved in missed test results, we developed a software prototype to account for technical, usability, organizational, and workflow needs. Our evaluation has shown the feasibility of the prototype as a means of facilitating better follow-up for cancer-related abnormal test results.
即使通过电子健康记录 (EHR) 基于警报的方式通知了提供者，异常的测试结果也并不总是会得到及时的跟进。高工作量、警报疲劳以及对注意力的其他需求会干扰提供者对启动跟进所需的任务的前瞻性记忆。因此，需要基于 EHR 的跟踪和提醒功能来改善跟进。
本研究的目的是开发一个决策支持软件原型，用于跟踪和记录缺乏跟进的异常测试结果警报，并进行形成性评估，包括可用性测试。
我们开发了一个工作原型软件系统，即 Alert Watch And Response Engine (AWARE)，用于检测缺乏记录的异常测试结果警报，并向提供者提供特定于上下文的提醒。开发和测试在 VA 的 EHR 中进行，重点关注四个与癌症相关的异常测试结果。设计理念强调减轻高工作量和警报疲劳的影响，同时保持最小的干扰。我们对软件进行了多方面的形成性评估，以解决其在更大的社会技术系统中的适应性问题。评估包括使用原型进行可用性测试，以及关于组织和工作流程因素的访谈问题。参与者包括 23 名医生、9 名临床信息技术专家和 8 名质量/安全经理。
评估结果表明，我们的软件原型适应于技术环境和临床工作流程，并且医生能够成功使用它。质量/安全经理报告说，该工具在未来的质量保证活动中检测缺乏记录的患者将非常有用。此外，我们还成功地在当地设施的“测试”EHR 系统上安装了该软件，从而证明了技术兼容性。
为了解决错过测试结果的因素，我们开发了一个软件原型，以满足技术、可用性、组织和工作流程的需求。我们的评估表明了原型作为促进与癌症相关的异常测试结果更好跟进的一种手段的可行性。
