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.
"An essential part of primary care, patient testing must be managed well to achieve the right care in the right time, amount, site, and setting with the right information and personnel in the right specialty (Hickner et al., 2005; Wakefield, Ward, & Wakefield, 2007). Non-standardized testing management decreases patient safety; increases clinician workload, costs, and delays; and worsens clinical outcomes (Battaglia et al., 2010; Schiff et al., 2009; H. Singh et al., 2009b; Wahls & Peleg, 2009; Wald et al., 2007). This research is focused on answering the test tracking and safety needs identified by a study of testing management practices in four Southwest Ohio primary care offices (Elder, McEwen, Flach, & Gallimore, 2009). "
[Show abstract][Hide abstract] ABSTRACT: As a gateway to specialty care, primary care relies on patient testing—including laboratory work and imaging—for many kinds of patient diagnoses and treatments. Because of this, patient safety can be adversely affected when testing orders are not tracked, results are lost, or patients are not notified of results. Non-standardized testing management also worsens clinical outcomes, lessens system resilience, and increases clinician workload, costs, and delays. During development of a system to better support patient test tracking, a survey was performed to assess perceptions, attitudes, and actions of current healthcare practitioners. Responses from 261 people show a variety of experience with the phrase "no news is good news" for testing results, attitudes and reactions about health technology, perceptions of usefulness and time consumption of safety-related actions, and failures and successes observed throughout testing management processes.
"i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s x x x ( 2 0 1 2 ) xxx–xxx 3 the service . Patients were satisfied when offered a secure patient portal to view their laboratory test results; and over half of the patients also accessed related reference information and there was no noticeable increase in patient concerns associated with knowing test results . Research conducted by Poon et al. found that care and communication provided via a personal health record has been well accepted by both patients and providers . "
[Show abstract][Hide abstract] ABSTRACT: Patients and health care providers often lack real time access to information at the bedside required to provide safe patient-centered care. Both groups identified pertinent information needed at the patient's bedside. The purpose of our research was to identify the essential data elements that will be used to define requirements for a useful bedside communication tool in the acute care hospital setting.
Descriptive research methods were used to identify bedside information requirements through group and individual interviews. Data from patients and health care providers were analyzed to identify common themes, compiled into a survey, and validated by both groups.
Thirty-seven information requirements were identified and classified under five themes: (1) plan of care, (2) patient education, (3) communication of safety alerts, (4) diet, and (5) medications. A survey completed by 30 patients and 30 health care providers confirmed 36 specific bedside information requirements (mean ≥ 5 on an 11-point scale). Patients and health providers each identified 24 specific information requirements that were similar in importance. When compared with nurses, significant differences were noted in the degree to which patients identified knowing the "daily routine schedule," e.g. when their doctor typically sees patients as a key requirement for the electronic bedside communication tool, t=3.52, p=.001.
Patients and health care providers identified information requirements at the bedside to promote self-care management of healthcare needs and an understanding of the hospital environment. Accurate, easily accessed information at the bedside is needed for providing safe patient-centered care.
International Journal of Medical Informatics 01/2012; 81(7):442-51. DOI:10.1016/j.ijmedinf.2011.12.005 · 2.00 Impact Factor
"Physicians have expressed concerns including: whether an abnormal result will alarm a patient unnecessarily; receipt of an avalanche of contact from worried patients; practice variations in timing of patient notification; malpractice risks; and an increase in un-reimbursed tasks.74 There are few published studies in this area, however, a feasibility study to introduce on-line laboratory results to patients in two primary care practices with 10 physicians reported that physicians had no increase in messages from their patients about inconsequential results showing that fears of unnecessary patient alarm may be unwarranted.74 If all patients are directly notified of their test results, they need to be able to read and understand the result and its implications.30 "
[Show abstract][Hide abstract] 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. DOI:10.1007/s11606-011-1949-5 · 3.42 Impact Factor
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