Automatic notification of test results: what doctors think

Missed or delayed test results are a significant safety problem, particularly in ambulatory and emergency department settings, and ICT has been proposed as one way to help solve it.

Patient empowerment is another, with several trials underway around the world being undertaken to study whether automatically notifying patients of abnormal results would encourage them to follow up the result with their doctor more quickly.

Clinicians, however, are reluctant to approve of the practice. In a new study to be presented at the Health Information Management Association of Australia's (HIMAA) national conference on the Gold Coast in October, Joanne Callen of the Centre for Health Systems and Safety Research (CHSSR) will present the findings of a new study that gauges clinicians' perspectives of automatically notifying patients of abnormal results.

The CHSSR, based at the University of NSW's Australian Institute of Health Innovation, is well known for the quality and breadth of its research into the effective use and exchange of information in improving the way in which healthcare is delivered. Led by Professor Johanna Westbrook, it has in recent years produced a remarkable amount of research into the safety of health systems, with an emphasis on the increasing use of technology to improve safety and patient outcomes.

One of its major areas of research is the use of technology for safe and efficient test management. Last year, it published a study in the Journal of Internal General Medicine of studies into the failure of clinicians in following up test results for ambulatory patients, along with a review of the safety implications of missed test results for hospitalised patients, published in the British Medical Journal Quality and Safety.

Associate Professor Callen, a senior research fellow at the CHSSR and a lead author on those papers, has a broad interest in patient perspectives and the belief that it is crucial to involve consumers if we are to realise the potential of health ICT.

“My research is placed within a socio-technical framework which acknowledges that the use of clinical information systems is contextual and outcomes can only be optimised if one takes into account the fit between the technology, organisation, person or team using the system, and the consumer,” Dr Callen said.

“Recently my research has focused on how to use information technology and other systems strategies to improve the safety of test result follow-up. Missed or delayed test results are a significant safety problem, particularly in ambulatory and emergency department settings. The use of ICT has been proposed as one strategy to help reduce the problem of missed test results.”

Dr Callen's study looked at what clinicians think about the direct notification of significantly abnormal test results – those that are not life-threatening but need short-term follow up, such as chest x-rays showing a new shadow or an abnormal prostate specific antigen (PSA) test.

“We have administered a cross-sectional survey to determine physician perceptions of automatic notifications of abnormal test results to patients in one hospital emergency department located in an Australian metropolitan area, Dr Callen said.

“The survey questions focus on practices for patient notification of significantly abnormal test results; institutional policies; responsibility for test notification; perceptions on automatic notification of results to patients, and participant demographic details.”

One of the reasons for the study was the dearth of published material on clinician and patient perspectives in a local context. The earlier JIGM paper, for example, was predominantly based on studies conducted in the US. It found that doctors expressed a number of concerns, including whether an abnormal result would alarm patients unnecessarily, perhaps leading to an “avalanche of contact from worried patients”.

The paper quoted several studies which have suggested that patients can play a role in detecting and preventing medical errors and could therefore have an enhanced role in the test result follow-up process. “Direct notification of test results to patients could serve as a safety net for providers and empower patients to be partners in their care,” the authors wrote.

So what do Australian clinicians think? Dr Callen's research showed mixed attitudes to patient notification, she said. “Preliminary results showed physicians’ key concerns related to perceptions of patient anxiety (89.5 per cent) and lack of expertise necessary to interpret test results (84.2 per cent).”

They also show that further exploration of treating physicians’ and laboratory staffs’ concerns should be undertaken. “Test result notification directly to patients, using electronic systems, requires further study and evaluation,” she said.

Dr Callen believes health information management professionals are ideally placed to undertake evaluation research related to the efficient and safe use of clinical information systems in all healthcare settings. “This study will assist those who are exploring ways of improving the management of test results across all healthcare settings to reduce the incidence of missed results.”

Posted in Australian eHealth

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