PPT - Implementation of an Electronic Test Result Management ...Presentation Transcript
Implementation of an Electronic Test Result Management System to Improve the Quality of Abnormal Test Result Followup Eric Poon, MD MPH; Bates, David, MD MSc; Gilad Kuperman, MD PhD; Qi Li, MD MBA; Pat Carchidi, RN; Sam Wang, MD PhD; Blackford Middleton, MD MSc; Tejal Gandhi, MD MPH Brigham and Women’s Hospital, Boston, MA Partners Information Systems, Boston, MA
Follow-up of test results in the primary care setting often a challenge:
High volume of test results
Test results arrive when physician not focused on the patient
Lack of systems to ensure reliability and efficiency
Room for improvement:
Patient and provider satisfaction
Clinical outcomes and patient safety
Objectives of Information Technology-Based Intervention
Improve efficiency and reliability of test result follow-up in the outpatient setting.
Improve adherence to established guidelines for the management of abnormal test results.
Improve patient satisfaction regarding communication of test results.
Description of Intervention: Results Manager (RM)
Electronic test results ‘inbox’ embedded into the home-grown electronic medical record.
Prioritizes degree of test result abnormality
Facilitates review of test results in context of patient’s history
Embeds guidelines to assist with decision making
Generates test result letters
Allows clinicians to set reminders for future testing.
Results Manager ‘Inbox’
Implementation of Results Manager
Spring 2003 -> Spring 2004
20 adult primary care practices affiliated with 2 academic medical centers
2 Training models explored:
Group demos + limited follow-up
Train the trainer (practice champions) with intensive follow-up
Usage of Results Manager
Results Manager Satisfaction Survey N=59, Response rate = 51% 0.9 1.9 RM2 is useful to me Standard Deviation Mean How Strongly do you agree with the following statements? (1= strong agree, 5=strongly disagree) 1.4 3.2 RM2 takes more time than before 1.1 2.3 RM2 is easy to use 0.9 2.1 RM decreases malpractice risk 0.9 1.8 RM improves care quality
Key Lessons Learned (1)
Use of systems such as RM has significant potential to improve quality and safety
Primary care physicians are in general receptive to the features offered by RM:
Active notification of test results
‘ One stop shopping’ for test results management
Review results in context
Write result letters
Key Lessons Learned (2)
Success factors for rapid adoption
Presence of physician champions
Practice ownership of adoption process
Physicians’ dissatisfaction with baseline paper-based processes
Key Lessons Learned (3)
Successful training strategies
Demonstrate how new intervention fits with local workflow needs
Hands-on training works better than didactic sessions
Don’t underestimate physicians’ need for training
Understand that introduction of new systems creates opportunities for new errors
Understand the limitations of the application and create fail-safe mechanisms
Eric Poon, MD MPH
Division of General Medicine and Primary Care
Brigham and Women’s Hospital, Boston MA
Clinical Informatics Research and Development
Partners Information Systems, Wellesley, MA
A Tragic Case of Delayed Diagnosis
JM presented in 1996 to a practice with a positive HIV test result
Repeat HIV test was done.
HIV result was negative, but result was never communicated to the patient.
Patient’s subsequent CD4 count were normal and viral loads were undetectable.
Patient was never put on anti-retroviral medications, but claims to have suffered significant emotional trauma
Mistake was discovered 8 years later.
Associated Press Aug 30 th 2004
Quality of Abnormal Test Result Follow-up: Room for Improvement
31% of women with abnormal mammograms do not receive care consistent with established guidelines (Haas, 2000)
39% of abnormal TSH at BWH not followed up within 60 days (Solomon, 1996)
36% of abnormal pap smear are ‘lost’ to follow-up (Marcus 1998)
More Ammunition: Burden of Outpatient Test Result Management
Per week, full-time PCP needs to review :
360 chemistry results (SMA7 = 7)
460 hematology results
12 pathology reports
40 radiology reports
57% of attending physicians surveyed report being not satisfied with the way they manage test results