EHRs Don't Ensure Speedy Lab Test Results

Even the best EHR on the market can't combat the social and technical challenges that hinder delivery of test results, a recent JAMIA report said.

Out of 2,590 primary care practitioners (PCPs) surveyed within the Department of Veteran's Affairs nationwide, 55.5% believe EHRs don't have convenient features for notifying patients of test results. Additionally, more than a third of those surveyed said they need more staff support for notifying patients of test results, while only 45.7% reported receiving adequate training on using an EHR test result notification system.

In an interview with InformationWeek Healthcare, Hardeep Singh, chief of health policy for the quality and informatics program at the Houston VA Health Services Research Center of Excellence, said he and his team set out to create a survey that they could use across multiple VA facilities, but, at the same time, was "connected to the rest of the world. …[W]e wanted to avoid the critique the work was only relevant to a VA setting. Years ago, EHRs weren't as commonly used in the private world, but now they are," he said.

Singh said the survey was developed with both social and technical issues affecting test management in mind. His team administered the survey online and included EHR test management content related to hardware, software and user interface; people; workflow and communication; organizational features; external rules and regulations; system measurement and monitoring; and new features and functions. "So technical dimensions, non-technical dimensions, organizational issues, monitoring issues -- we wanted to make sure we addressed them all," he said.

[ For another point of view on PHRs, see Why Personal Health Records Have Flopped. ]

Consistent with previous studies, the report found that 46.1% of providers rely on additional patient visits to notify them of normal test results, while 20.1% rely on a next visit to relay abnormal test result information.

What was surprising, said Singh, was that 85.6% of PCPs reported having to stay after hours or come in on weekends to address EHR test result alerts; only 30.1% of respondents reported receiving "protected time," according to the report. "Very few have time to take care of [alerts], and that's an organizational issue," he said. "PCPs are spending so much time on this, and this was one of the things we were able to quantify."

Considering the fact that the VA has "good training overall," Singh and his team thought providers would have undergone adequate training as well on alerts and systems. But in fact, less than half reported having received sufficient training on the VA EHR system, and only 13.7% reported receiving "refresher training."

The survey suggested a series of interventions to better manage test results within an EHR system. For example, according to the report, the ability to "easily retrieve and readily access critical test result data is an absolute requirement for safe and efficient care, and the ability to do so was endorsed by a large majority of respondents." Therefore, EHR design should better allow for PCPs to return to a deleted notification or an alert processed some time ago, the report suggested.

The study concluded that a "comprehensive, socio-technical approach" is needed to help improve EHR test result management. Key components of this approach include the better design, development and testing of features to support physician workflows; new policies and procedures regarding appropriate methods and timeliness of patient notification; and commitments from leadership to support the additional non-face-to-face work required to provide care for patients in an EHR-enabled system.

Feedback from provider organizations outside the VA seems to confirm the report findings. "They're saying the same things, and they agree EHRs have a way to go before they can have an impact on important things, especially Meaningful Use efforts on structured lab reporting," said Singh.

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