The management of test results in primary care: does an electronic medical record make a difference?

BACKGROUND AND OBJECTIVES

It is unknown whether an electronic medical record (EMR) improves the management of test results in primary care offices.

METHODS

As part of a larger assessment using observations, interviews, and chart audits at eight family medicine offices in SW Ohio, we documented five results management steps (right place in chart, signature, interpretation, patient notification, and abnormal result follow-up) for laboratory and imaging test results from 25 patient charts in each office. We noted the type of records used (EMR or paper) and how many management steps had standardized results management processes in place.

RESULTS

We analyzed 461 test results from 200 charts at the eight offices. Commonly grouped tests (complete blood counts, etc) were considered a single test. A total of 274 results were managed by EMR (at four offices). Results managed with an EMR were more often in the right place in the chart (100% versus 98%), had more clinician signatures (100% versus 86%), interpretations (73% versus 64%), and patient notifications (80% vs. 66%) documented. For the subset of abnormal results (n=170 results), 64% of results managed with an EMR had a follow-up plan documented compared to only 40% of paper managed results. Having two or more standardized results management steps did not significantly improve documentation of any step, but no offices had standardized processes for documenting interpretation of test results or follow-up for abnormal results. There was inter-office variability in the successful documentation of results management steps, but 75% of the top performing offices had EMRs.

CONCLUSIONS

There was greater documentation of results managed by an EMR, but all offices fall short in notifying patients and in documenting interpretation and follow-up of abnormal test results.

Management of test results in family medicine offices

PURPOSE

We wanted to explore test results management systems in family medicine offices and to delineate the components of quality in results management.

METHODS

Using a multimethod protocol, we intensively studied 4 purposefully chosen family medicine offices using observations, interviews, and surveys. Data analysis consisted of iterative qualitative analysis, descriptive frequencies, and individual case studies, followed by a comparative case analysis. We assessed the quality of results management at each practice by both the presence of and adherence to systemwide practices for each results management step, as well as outcomes from chart reviews, patient surveys, and interview and observation notes.

RESULTS

We found variability between offices in how they performed the tasks for each of the specific steps of results management. No office consistently had or adhered to office-wide results management practices, and only 2 offices had written protocols or procedures for any results management steps. Whereas most patients surveyed acknowledged receiving their test results (87% to 100%), a far smaller proportion of patient charts documented patient notification (58% to 85%), clinician response to the result (47% to 84%), and follow-up for abnormal results (28% to 55%). We found 2 themes that emerged as factors of importance in assessing test results management quality: safety awareness-a leadership focus and communication that occurs around quality and safety, teamwork in the office, and the presence of appropriate policies and procedures; and technological adoption-the presence of an electronic health record, digital connections between the office and testing facilities, use of technology to facilitate patient communication, and the presence of forcing functions (built-in safeguards and requirements).

CONCLUSION

Understanding the components of safety awareness and technological adoption can assist family medicine offices in evaluating their own results management processes and help them design systems that can lead to higher quality care.