Sharing electronic laboratory results in a patient portal--a feasibility pilot.
ABSTRACT Surveys of patients consistently demonstrate a very strong interest in having secure electronic access to their own laboratory test results. In recent years, a number of health care providers and lab service centers have offered this capability, which now extends to millions of patients in the United States. Yet, little has been published on the methods of making lab results available. This case report identifies the objectives, methods, and results of a feasibility pilot conducted at Partners Healthcare from May to September, 2006. A candidate set of results were identified, approved for release, programmed into Patient Gateway, Partners' secure patient portal, and studied. Patient and practice feedback was positive. No noticeable rise in patient concerns was observed by practice staff or through patient surveys. One-half of patients who viewed results accessed reference information linked to a result. Organizational and practice-level issues necessary to support continued rollout are described.
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ABSTRACT: Serious lapses in patient care result from failure to follow-up test results. To systematically review evidence quantifying the extent of failure to follow-up test results and the impact for ambulatory patients. Medline, CINAHL, Embase, Inspec and the Cochrane Database were searched for English-language literature from 1995 to 2010. Studies which provided documented quantitative evidence of the number of tests not followed up for patients attending ambulatory settings including: outpatient clinics, academic medical or community health centres, or primary care practices. Four reviewers independently screened 768 articles. Nineteen studies met the inclusion criteria and reported wide variation in the extent of tests not followed-up: 6.8% (79/1163) to 62% (125/202) for laboratory tests; 1.0% (4/395) to 35.7% (45/126) for radiology. The impact on patient outcomes included missed cancer diagnoses. Test management practices varied between settings with many individuals involved in the process. There were few guidelines regarding responsibility for patient notification and follow-up. Quantitative evidence of the effectiveness of electronic test management systems was limited although there was a general trend towards improved test follow-up when electronic systems were used. Most studies used medical record reviews; hence evidence of follow-up action relied upon documentation in the medical record. All studies were conducted in the US so care should be taken in generalising findings to other countries. Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery.Journal of General Internal Medicine 12/2011; 27(10):1334-48. · 3.42 Impact Factor
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ABSTRACT: Diagnostic errors (missed, delayed or wrong diagnosis) have recently gained attention and are associated with significant preventable morbidity and mortality. The authors reviewed the recent literature and identified interventions that address system-related factors that contribute directly to diagnostic errors. The authors conducted a comprehensive search using multiple search strategies. First, they performed a PubMed search to identify articles exclusively related to diagnostic error or delay published in English between 2000 and 2009. They then sought papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, papers were also included if interventions were suggested and not tested to inform the state of the science on the subject. Interventions were characterised according to the step in the diagnostic process they targeted: patient-provider encounter; performance and interpretation of diagnostic tests; follow-up and tracking of diagnostic information; subspecialty and referral-related issues; and patient-specific care-seeking and adherence processes. 43 articles were identified for full review, of which six reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, although somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or healthcare sites. Outcome measures in general were underdeveloped and varied markedly among studies, depending on the setting or step in the diagnostic process. Despite a number of suggested interventions in the literature, few empirical studies in the past decade have tested interventions to reduce diagnostic errors. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects.BMJ quality & safety 11/2011; 21(2):160-70. · 3.28 Impact Factor
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ABSTRACT: Abstract Objective: To describe parent feedback and intention to use the patient portal related to their children's health records after a facilitated learning session. Patient portals are Internet-based, self-service models for health account information and records that allow patients or parents to be more proactive in their healthcare. Materials and Methods: A navigator demonstrated the patient portal to parents using on-site kiosks at a pediatric clinic. Parents ≥18 years of age completed an institutional review board-approved survey. Results: Of those approached, 171 (54%) parents participated in the demonstration; 64 (37%) completed surveys. Average age was 28 years (standard deviation 7), and most were white (26, 40%) or Hispanic (14, 22%). Most (46, 72%) did not know about the patient portal prior to demonstration; of those who did, only five (28%) had used it. Following demonstration, the majority (59, 92%) thought the patient portal was easy to use. Parents planned to view medical records and laboratory results but disliked having separate accounts for each child and the lack of a "symptom checker." Many (44, 69%) planned for future use. The majority (62, 97%) found the navigator helpful, and (37, 58%) wanted access to the patient portal via on-site kiosks. Conclusions: Although most parents had no prior experience with the patient portal, they were satisfied overall with ease of use and offered features. Clinics should consider (1) hands-on demonstrations of the patient portal to encourage understanding and use and (2) alternative access venues if home computers are not available.Telemedicine and e-Health 09/2013; · 1.40 Impact Factor