Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States.
Appl Clin Inform. 2022 May;13(3):681-691. doi: 10.1055/s-0042-1751092. Epub 2022 Jul 13.
Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied.
The purpose of this study was to develop an understanding of when and how a provider decides to use a subscription-based electronic notification. Better appreciation for the factors that contribute to selecting such notifications could aid in improving the functionality of these tools.
We performed an 8-month quantitative assessment of 3,291 notifications and a qualitative survey assessment of 73 providers who utilized an elective notification tool in our electronic health record.
We found that most notifications were requested by attending physicians (∼60%) and from internal medicine specialty (∼25%). Most providers requested only a few notifications while a small minority (nearly 5%) requested 10 or more in the study period. The majority (nearly 30%) of requests were for chemistry laboratories. Survey respondents reported using the tool predominantly for important or time-sensitive laboratories. Overall opinions of the tool were positive (median = 7 out of 10, 95% confidence interval: 6-9), with 40% of eligible respondents reporting the tool improved quality of care. Reported examples included time to result review, monitoring of heparin drips, and reviewing pathology results.
Developing an understanding for when and how providers decide to be notified of clinical results can help aid in the design and improvement of clinical tools, such as improved elective notifications. These tools may lead to reduced time to result review which could in turn improve clinical care quality.
自动化电子结果通知可以提醒医疗保健提供者注意重要的临床结果。与主要关注临界实验室异常且通常不太可定制的传统通知系统相比，现代电子健康记录提供了基于订阅的电子通知功能。但这一功能尚未得到充分研究。
本研究旨在了解提供者何时以及如何决定使用基于订阅的电子通知。更好地了解促成选择此类通知的因素可能有助于改进这些工具的功能。
我们对 3291 个通知进行了 8 个月的定量评估，并对 73 名在电子病历中使用可选通知工具的提供者进行了定性调查评估。
我们发现，大多数通知是主治医生（约 60%）请求的，来自内科专业（约 25%）。大多数提供者只请求少数通知，而少数（近 5%）在研究期间请求了 10 个或更多通知。大多数请求（近 30%）是化学实验室。调查受访者报告主要将该工具用于重要或时间敏感的实验室。对该工具的总体评价是积极的（中位数为 7 分，95%置信区间：6-9），40%符合条件的受访者报告该工具提高了护理质量。报告的示例包括结果审查时间、肝素滴注监测和病理结果审查。
了解提供者何时以及如何决定通知临床结果，可以帮助设计和改进临床工具，例如改进可选通知。这些工具可能会减少结果审查时间，从而提高临床护理质量。
