Provider management strategies of abnormal test result alerts: a cognitive task analysis
- Sylvia J Hysong1,2,
- Mona K Sawhney1,2,
- Lindsay Wilson1,2,
- Dean F Sittig3,4,
- Donna Espadas1,2,
- Traber Davis1,2,
- Hardeep Singh1,2
- 1Houston VA HSR&D Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- 2The 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, USA
- 3University of Texas School of Health Information Sciences, Houston, Texas, USA
- 4University of Texas—Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
- Correspondence to Dr S J Hysong, Houston VA Health Services Research and Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research & Development, Center of Excellence (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; hysong{at}bcm.edu
- Received 3 March 2009
- Accepted 10 September 2009
Abstract
Objective Electronic medical records (EMRs) facilitate abnormal test result communication through “alert” notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results.
Design 28 PCPs from a large, tertiary care Veterans Affairs Medical Center (VAMC) were purposively sampled according to their rates of timely follow-up of alerts, determined in a previous study. Using techniques from cognitive task analysis, participants were interviewed about how and when they manage alerts, focusing on four alert-management features to filter, sort and reduce unnecessary alerts on their EMR screens.
Results Provider knowledge of alert-management features ranged between 4% and 75%. Almost half (46%) of providers did not use any of these features, and none used more than two. Providers with higher versus lower rates of timely follow-up used the four features similarly, except one (customizing alert notifications). Providers with low rates of timely follow-up tended to manually scan the alert list and process alerts heuristically using their clinical judgment. Additionally, 46% of providers used at least one workaround strategy to manage alerts.
Conclusion Considerable heterogeneity exists in provider use of alert-management strategies; specific strategies may be associated with lower rates of timely follow-up. Standardization of alert-management strategies including improving provider knowledge of appropriate tools in the EMR to manage alerts could reduce the lack of timely follow-up of abnormal diagnostic test results.
- medical records systems
- computerized
- task performance and analysis
- diagnostic errors/classification
- primary healthcare
- software
Footnotes
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An earlier version of this work was presented as an abstract on 29 June 2009 at the 2009 Academy Health Annual Research Meeting.
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Funding The research reported here was supported in part by a VA Career Development Award (CD2-07-0818) to SJH, the VA National Center of Patient Safety, and the Houston VA HSR&D Center of Excellence (HFP90-020). Other funders: VA Career Development Award; VA National Center of Patient Safety; Houston VA HSR&D Center of Excellence.
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Competing interests None.
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Provenance and peer review Not commissioned; not externally peer reviewed.
