Research Activities, October 2010: Safety/Quality of Care: Timely followup remains an issue with abnormal lab results in electronic health records

Safety/Quality of Care
Timely followup remains an issue with abnormal lab results in electronic health records

One of the areas in outpatient practices subject to error is the followup of abnormal lab results. Missed test results lead to delays in diagnosis and potential adverse events as well as subjecting clinicians and practices to legal liability. Use of electronic health records (EHRs) facilitates transmission of abnormal outpatient laboratory test results to clinicians through "alerts." However, safety concerns remain when it comes to the followup practices of clinicians, concludes a new study.

Researchers focused on four abnormal test alerts in EHRs: hemoglobin A1c, frequently used to monitor diabetes; positive hepatitis C antibody, used to diagnose hepatitis C infection; prostate-specific antigen that may predict prostate cancer; and thyroid stimulating hormone, used to diagnose thyroid dysfunction. Alerts were tracked to determine if the provider acknowledged the alert by clicking on and opening up the message about the abnormal lab results within a 2-week period. After 30 days, medical records were reviewed and providers contacted to see if any followup actions took place, such as contacting the patient about the abnormal lab result and/or implementing treatment.

During a 10-month period, a total of 78,158 tests for the four measurements were performed. Of these, 1.48 percent were transmitted to the providers as alerts in the EHR. While 10.2 percent of the alerts were not acknowledged by the provider, lack in the timely followup was seen in 6.8 percent of all alerts after 30 days. Alerts related to redundant tests were more likely to receive followup. Alerts issued for conditions that indicated a new diagnosis were more likely to lack timely followup compared with alerts for pre-existing conditions. More research and interventions are needed to improve the human-computer interface and to monitor followup actions by providers, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS17244).

See "Notification of abnormal lab test results in an electronic medical record: Do any safety concerns remain?" by Hardeep Singh, M.D., M.P.H., Eric J. Thomas, M.D., M.P.H., Dean F. Sittig, Ph.D., and others in the March 2010 The American Journal of Medicine 123(3), pp. 238-244.

Research Activities, October 2010: Safety/Quality of Care: Timely followup remains an issue with abnormal lab results in electronic health records