Primary Care Providers’ Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets

Cutrona, Sarah L.; Fouayzi, Hassan; Burns, Laura; Sadasivam, Rajani S.; Mazor, Kathleen M.; Gurwitz, Jerry H.; Garber, Lawrence; Sundaresan, Devi; Houston, Thomas K.; Field, Terry S.

doi:10.1007/s11606-017-4146-3

Cited by 23 publications

(29 citation statements)

References 30 publications

(62 reference statements)

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“…Studies have documented the large numbers of alerts PCPs receive, which may result in alert fatigue or contribute to provider burnout. [33][34][35][36][37][38] Thus, efficient processes for managing test results is critical. Others report successful implementation of team-based approaches for test results management.…”

Section: Discussionmentioning

confidence: 99%

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Danforth

Hahn

Slezak

et al. 2019

American Journal of Kidney Diseases

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Background: Timely follow-up of abnormal laboratory results is important for high-quality care. We sought to identify risk factors, facilitators, and barriers to timely follow-up of an abnormal estimated glomerular filtration rate (eGFR) for the diagnosis of chronic kidney disease. Study Design: Mixed-methods study: retrospective electronic health record (EHR) analyses, physician interviews. Setting & Participants: Large integrated health care delivery system. Quantitative analyses included 244,540 patients 21 years or older with incident abnormal eGFRs from January 1, 2010, to December 31, 2015, ordered by 7,164 providers. Qualitative analyses included 15 physician interviews. Exposures: Patient-, physician-, and system-level factors. Outcome: Timely follow-up of incident abnormal eGFRs, defined as repeat eGFR obtained within 60 to 150 days, follow-up testing before 60 days that indicated normal kidney function, or diagnosis before 60 days of chronic kidney disease or kidney cancer. Analytical Approach: Multivariable robust Poisson regression models accounting for clustering within provider were used to estimate risk ratios (RRs) and 95% CIs for lack of timely follow-up. Team coding was used to identify themes from physician interviews. Results: 58% of patients lacked timely follow-up of their incident abnormal eGFRs (ie, had a care gap). An abnormal creatinine result flag in the EHR was associated with better follow-up (RR for care gap, 0.65; 95% CI, 0.64-0.66). Patient online portal use and physician panel size were weakly associated with follow-up. Patients seen by providers behind on managing their EHR message box were at higher risk for care gaps. Physician interviews identified system-level (eg, panel size and assistance in managing laboratory results) and provider-level (eg, proficiency using EHR tools) factors that influence laboratory result management. Limitations: Unable to capture intentional delays in follow-up testing. Conclusions: Timely follow-up of abnormal results remains challenging in an EHR-based integrated health care delivery system. Strategies improving provider EHR message box management and leveraging health information technology (eg, flagging abnormal eGFR results), making organizational/staffing changes (eg, increasing the role of nurses in managing laboratory results), and boosting patient engagement through better patient portals may improve test follow-up. Complete author and article information provided before references.

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Section: Discussionmentioning

confidence: 99%

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Danforth

Hahn

Slezak

et al. 2019

American Journal of Kidney Diseases

View full text Add to dashboard Cite

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“…Excessive inbox messages can also lead to loss of situational awareness (SA), 17 an aviation concept which has been recently applied to medicine to better understand decision-making in dynamic clinical settings, including decision-making related to EHRbased notifications. 18 SA involves four levels: (1) perception of elements in the environment, (2) comprehension of their meaning, (3) projection of their status in the near future, and (4) awareness of best path to follow.…”

Section: Introductionmentioning

confidence: 99%

Practicing Clinicians’ Recommendations to Reduce Burden from the Electronic Health Record Inbox: a Mixed-Methods Study

et al. 2019

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“…The programme also had local carryover effects, which we were not able to measure systematically. These pressing questions merit further research to fully understand the complexity of use of EHR-based communication systems 23…”

Section: Discussionmentioning

confidence: 99%

Impact of a national QI programme on reducing electronic health record notifications to clinicians

et al. 2018

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Background Emerging evidence suggests electronic health record (EHR)-related information overload is a risk to patient safety. In the US Department of Veterans Affairs (VA), EHR-based 'inbox' notifications originally intended for communicating important clinical information are now cited by 70% of primary care practitioners (PCPs) to be of unmanageable volume. We evaluated the impact of a national, multicomponent, quality improvement (QI) programme to reduce low-value EHR notifications. Methods The programme involved three steps: (1) accessing daily PCP notification load data at all 148 facilities operated nationally by the VA; (2) standardising and restricting mandatory notification types at all facilities to a recommended list; and (3) hands-on training for all PCPs on customising and processing notifications more effectively. Designated leaders at each of

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Primary Care Providers’ Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets

Abstract: The number of total InBasket notifications and weekend delivery may impact the opening of time-sensitive EHR alerts. Further study is needed to support safe and effective approaches to care team management of InBasket notifications.

Cited by 23 publications

References 30 publications

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Follow-up of Abnormal Estimated GFR Results Within a Large Integrated Health Care Delivery System: A Mixed-Methods Study

Practicing Clinicians’ Recommendations to Reduce Burden from the Electronic Health Record Inbox: a Mixed-Methods Study

Impact of a national QI programme on reducing electronic health record notifications to clinicians

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