Article

Unintended errors with EHR-based result management: a case series.

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon 97239, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 01/2010; 17(1):104-7. DOI: 10.1197/jamia.M3294
Source: PubMed

ABSTRACT Test result management is an integral aspect of quality clinical care and a crucial part of the ambulatory medicine workflow. Correct and timely communication of results to a provider is the necessary first step in ambulatory result management and has been identified as a weakness in many paper-based systems. While electronic health records (EHRs) hold promise for improving the reliability of result management, the complexities involved make this a challenging task. Experience with test result management is reported, four new categories of result management errors identified are outlined, and solutions developed during a 2-year deployment of a commercial EHR are described. Recommendations for improving test result management with EHRs are then given.

Download full-text

Full-text

Available from: Thomas R Yackel, Jun 25, 2015
1 Follower
 · 
73 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To date, little research has been published on the impact that the transition from paper-based record keeping to the use of electronic health records (EHR) has on performance on clinical quality measures. This study examines whether small, independent medical practices improved in their performance on nine clinical quality measures soon after adopting EHRs. Data abstracted by manual review of paper and electronic charts for 6,007 patients across 35 small, primary care practices were used to calculate rates of nine clinical quality measures two years before and up to two years after EHR adoption. For seven measures, population-level performance rates did not change before EHR adoption. Rates of antithrombotic therapy and smoking status recorded increased soon after EHR adoption; increases in blood pressure control occurred later. Rates of hemoglobin A1c testing, BMI recorded, and cholesterol testing decreased before rebounding; smoking cessation intervention, hemoglobin A1c control and cholesterol control did not significantly change. The effect of EHR adoption on performance on clinical quality measures is mixed. To improve performance, practices may need to develop new workflows and adapt to different documentation methods after EHR adoption. In the short term, EHRs may facilitate documentation of information needed for improving the delivery of clinical preventive services. Policies and incentive programs intended to drive improvement should include in their timelines consideration of the complexity of clinical tasks and documentation needed to capture performance on measures when developing timelines, and should also include assistance with workflow redesign to fully integrate EHRs into medical practice.
    12/2015; 3(1):1131. DOI:10.13063/2327-9214.1131
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-analytical laboratory processes have been considered to be less prone to error than preanalytical processes because of the widespread adoption of laboratory automation and interfaced laboratory reporting. Quality monitors and controls for the post-analytical process have focused on critical result notification, meeting established turnaround time goals, and review of changed reports. The rapid increase in the adoption of electronic health records has created a new role for laboratory professionals in the management of patient test results. Laboratory professionals must interface with the clinical side of the health care team in establishing quality control for post-analytical processes, particularly in high-risk transitions of care.
    Clinics in laboratory medicine 03/2013; 33(1):183-194. DOI:10.1016/j.cll.2012.10.001 · 1.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives The intent of this paper is in the examination of health IT implementation processes - the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. Methods A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the Framework for Implementation Research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability. Results Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, “one size fits all” in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as “scaffolding” to begin to assess best practices, their distinct dimensions, and their applicability for use. Conclusions Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no “one size fits all”, there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.
    International Journal of Medical Informatics 01/2013; 83(7). DOI:10.1016/j.ijmedinf.2013.10.009 · 2.72 Impact Factor