Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation

Abstract

Background Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied.

Objectives The purpose of this study was to develop an understanding of when and how a provider decides to use a subscription-based electronic notification. Better appreciation for the factors that contribute to selecting such notifications could aid in improving the functionality of these tools.

Methods We performed an 8-month quantitative assessment of 3,291 notifications and a qualitative survey assessment of 73 providers who utilized an elective notification tool in our electronic health record.

Results We found that most notifications were requested by attending physicians (∼60%) and from internal medicine specialty (∼25%). Most providers requested only a few notifications while a small minority (nearly 5%) requested 10 or more in the study period. The majority (nearly 30%) of requests were for chemistry laboratories. Survey respondents reported using the tool predominantly for important or time-sensitive laboratories. Overall opinions of the tool were positive (median = 7 out of 10, 95% confidence interval: 6–9), with 40% of eligible respondents reporting the tool improved quality of care. Reported examples included time to result review, monitoring of heparin drips, and reviewing pathology results.

Conclusion Developing an understanding for when and how providers decide to be notified of clinical results can help aid in the design and improvement of clinical tools, such as improved elective notifications. These tools may lead to reduced time to result review which could in turn improve clinical care quality.

Keywords

notifications - alerts - asynchronous - quality - electronic health records

Publikationsverlauf

Eingereicht: 11. Januar 2022

Angenommen: 25. Mai 2022

Artikel online veröffentlicht:
13. Juli 2022

• References

• 1 Henry J, Pylypchuk Y, Searcy T. et al. Adoption of electronic health record systems among US non-federal acute care hospitals: 2008–2015. ONC Data Brief 2016; 35: 1-9
• 2 Salmasian H, Landman AB, Morris C. An electronic notification system for improving patient flow in the emergency department. AMIA Jt Summits Transl Sci Proc 2019; 2019: 242-247
• 3 Mamykina L, Vawdrey DK, Hripcsak G. How do residents spend their shift time? A time and motion study with a particular focus on the use of computers. Acad Med 2016; 91 (06) 827-832
• 4 Sinsky C, Colligan L, Li L. et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
• 5 Slovis BH, Nahass TA, Salmasian H, Kuperman G, Vawdrey DK. Asynchronous automated electronic laboratory result notifications: a systematic review. J Am Med Inform Assoc 2017; 24 (06) 1173-1183
• 6 Samal L, Stavroudis T, Miller R, Lehmann H, Lehmann C. Effect of a laboratory result pager on provider behavior in a neonatal intensive care unit. Appl Clin Inform 2011; 2 (03) 384-394
• 7 Kuperman GJ, Teich JM, Bates DW. et al. Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system. Proc AMIA Annu Fall Symp 1996; 704-708
• 8 Tate KE, Gardner RM, Scherting K. Nurses, pagers, and patient-specific criteria: three keys to improved critical value reporting. Proc Annu Symp Comput Appl Med Care 1995; 164-168
• 9 Etchells E, Adhikari NK, Cheung C. et al. Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values–a randomised controlled trial. Qual Saf Health Care 2010; 19 (02) 99-102
• 10 Kuperman GJ, Teich JM, Tanasijevic MJ. et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999; 6 (06) 512-522
• 11 O'Connor SD, Khorasani R, Pochebit SM, Lacson R, Andriole KP, Dalal AK. Semiautomated system for nonurgent, clinically significant pathology results. Appl Clin Inform 2018; 9 (02) 411-421
• 12 ONC. 2015 Edition Market Readiness for Hospitals and Clinicians. Health IT Quick-Stat #55. Office of the National Coordinator for Health Information Technology; March 2019. Accessed June 12, 2022 at: https://www.healthit.gov/data/quickstats/2015-edition-market-readiness-hospitals-and-clinicians
• 13 Friedman CPA. A “fundamental theorem” of biomedical informatics. J Am Med Inform Assoc 2009; 16 (02) 169-170
• 14 Arndt BG, Beasley JW, Watkinson MD. et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med 2017; 15 (05) 419-426
• 15 Poon EG, Kuperman GJ, Fiskio J, Bates DW. Real-time notification of laboratory data requested by users through alphanumeric pagers. J Am Med Inform Assoc 2002; 9 (03) 217-222
• 16 Melnick ER, Dyrbye LN, Sinsky CA. et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc 2020; 95 (03) 476-487
• 17 Koziatek C, Swartz J, Iturrate E, Levy-Lambert D, Testa P. Decreasing the lag between result availability and decision-making in the emergency department using push notifications. West J Emerg Med 2019; 20 (04) 666-671
• 18 About Us. Thomas Jefferson University, 2021. Accessed June 16 2022 at: https://hospitals.jefferson.edu/about-us.html.
• 19 De Chesnay M. Nursing Research Using Grounded Theory: Qualitative Designs and Methods in Nursing. New York, NY: Springer Publishing Company, LLC; 2015
• 20 Piva E, Sciacovelli L, Zaninotto M, Laposata M, Plebani M. Evaluation of effectiveness of a computerized notification system for reporting critical values. Am J Clin Pathol 2009; 131 (03) 432-441
• 21 Chen TC, Lin WR, Lu PL. et al. Computer laboratory notification system via short message service to reduce health care delays in management of tuberculosis in Taiwan. Am J Infect Control 2011; 39 (05) 426-430
• 22 Liebow EB, Derzon JH, Fontanesi J. et al. Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012; 45 (13–14): 979-987
• 23 Verma A, Wang AS, Feldman MJ, Hefferon DA, Kiss A, Lee JS. Push-alert notification of troponin results to physician smartphones reduces the time to discharge emergency department patients: a randomized controlled trial. Ann Emerg Med 2017; 70 (03) 348-356
• 24 Menon S, Murphy DR, Singh H, Meyer AN, Sittig DF. Workarounds and test results follow-up in electronic health record-based primary care. Appl Clin Inform 2016; 7 (02) 543-559