Appl Clin Inform - Developing software to track and catch missed follow-up of abnormal test results in a complex sociotechnical environment.

Tópicos

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Resumo

CKGROUND: Abnormal test results do not always receive timely follow-up, even when providers are notified through electronic health record (EHR)-based alerts. High workload, alert fatigue, and other demands on attention disrupt a provider's prospective memory for tasks required to initiate follow-up. Thus, EHR-based tracking and reminding functionalities are needed to improve follow-up.OBJECTIVES: The purpose of this study was to develop a decision-support software prototype enabling individual and system-wide tracking of abnormal test result alerts lacking follow-up, and to conduct formative evaluations, including usability testing.METHODS: We developed a working prototype software system, the Alert Watch And Response Engine (AWARE), to detect abnormal test result alerts lacking documented follow-up, and to present context-specific reminders to providers. Development and testing took place within the VA's EHR and focused on four cancer-related abnormal test results. Design concepts emphasized mitigating the effects of high workload and alert fatigue while being minimally intrusive. We conducted a multifaceted formative evaluation of the software, addressing fit within the larger socio-technical system. Evaluations included usability testing with the prototype and interview questions about organizational and workflow factors. Participants included 23 physicians, 9 clinical information technology specialists, and 8 quality/safety managers.RESULTS: Evaluation results indicated that our software prototype fit within the technical environment and clinical workflow, and physicians were able to use it successfully. Quality/safety managers reported that the tool would be useful in future quality assurance activities to detect patients who lack documented follow-up. Additionally, we successfully installed the software on the local facility's "test" EHR system, thus demonstrating technical compatibility.CONCLUSION: To address the factors involved in missed test results, we developed a software prototype to account for technical, usability, organizational, and workflow needs. Our evaluation has shown the feasibility of the prototype as a means of facilitating better follow-up for cancer-related abnormal test results.

Resumo Limpo

ckground abnorm test result alway receiv time followup even provid notifi electron health record ehrbas alert high workload alert fatigu demand attent disrupt provid prospect memori task requir initi followup thus ehrbas track remind function need improv followupobject purpos studi develop decisionsupport softwar prototyp enabl individu systemwid track abnorm test result alert lack followup conduct format evalu includ usabl testingmethod develop work prototyp softwar system alert watch respons engin awar detect abnorm test result alert lack document followup present contextspecif remind provid develop test took place within vas ehr focus four cancerrel abnorm test result design concept emphas mitig effect high workload alert fatigu minim intrus conduct multifacet format evalu softwar address fit within larger sociotechn system evalu includ usabl test prototyp interview question organiz workflow factor particip includ physician clinic inform technolog specialist qualitysafeti managersresult evalu result indic softwar prototyp fit within technic environ clinic workflow physician abl use success qualitysafeti manag report tool use futur qualiti assur activ detect patient lack document followup addit success instal softwar local facil test ehr system thus demonstr technic compatibilityconclus address factor involv miss test result develop softwar prototyp account technic usabl organiz workflow need evalu shown feasibl prototyp mean facilit better followup cancerrel abnorm test result

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