Study Reports Primary Care Practitioners' Views on VA's Electronic Health Record System and Test Result Notification
Electronic health records (EHRs) are increasingly used to notify practitioners of patients' abnormal test results. However, ensuring appropriate test result follow-up remains challenging, even with electronic transmission. This cross-sectional study examined the broad range of social and technical factors that affect test result management in the VA healthcare system. Between June and November 2010, investigators conducted a web-based survey of primary care practitioners (PCPs) at 142 VA facilities nationwide. Of the 5,001 PCPs invited to participate, 2,590 (52%) responded. In addition to demographics, the survey assessed the following EHR-related areas: hardware/software, content, and user interface related to VA's "View Alert" system in CPRS; workflow and communication (e.g., perceptions of alert burden); organizational features (e.g., tech support for help on alert notifications); external rules and regulations; system measurement and monitoring (e.g., monitoring alert follow-up); and new features and functions that could improve EHR-based test result notification.
- Despite an advanced EHR system, VA PCPs reported both social and technical challenges in ensuring notification of test results to practitioners and Veterans.
- The vast majority of PCPs in this study had considerable experience with VA's EHR, but less than half (46%) reported receiving sufficient training on the "View Alert" system. Nevertheless, the majority believed they had knowledge (74%) and proficiency (82%) to use the View Alert system.
- Just over one-third of the PCPs reported having the help needed for notifying patients of test results. Almost half of the PCPs reported that they did not immediately notify patients of normal test results and relied on patients' next visit to notify them, whereas about one-fifth relied on the next visit to report abnormal results.
- A majority of PCPs (86%) stayed after hours or came in on weekends to address patient notifications, and less than one-third (30%) reported receiving protected time for alert management.
- Nearly half of the PCPs (47%) had prior experience using a non-VA EHR. Of these, 55% indicated that VA's CPRS was superior to other commercially-available EHRs they had used, 19% thought that the non-VA EHR they used was superior, and 26% perceived them to be the same.
- PCPs endorsed several new features to improve test result management, including better tracking and visualization of result notifications.
- Authors suggest a comprehensive socio-technical approach to optimize EHR-based test result management that includes the design, development, and use of new EHR features and functions to support physicians' test result management workflows.
- The study had a relatively low response rate, although comparable to or higher than other PCP surveys.
- Demographic or practice-based characteristics of non-respondents were unavailable for comparison.
This study was partly supported by HSR&D and VA's National Center for Patient Safety (NCPS). Dr. Singh is Director of the Houston VA Patient Safety Center of Inquiry, funded by the NCPS. Drs. Singh and Petersen are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.
Singh H, Spitzmueller C, Petersen NJ, et al. Primary Care Practitioners’ Views on Test Result Management in EHR-Enabled Health Systems: A National Survey. Journal of the American Medical Informatics Association December 25, 2012;e-pub ahead of print.