ArticleApplied clinical informatics2013
Developing software to "track and catch" missed follow-up of abnormal test results in a complex sociotechnical environment.
Article in Applied clinical informatics, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 31 citations in OpenAlex.
- Primary Care Providers' Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets.Journal of general internal medicine · 2017Trial
- Preventing lost-to-follow up diagnostic imaging in ambulatory care: evaluation of an electronic notification tool.BMJ open quality · 2023Article
- A Fact-Finding Procedure Integrating Machine Learning and AHP Technique to Predict Delayed Diagnosis of Bladder Patients with Hematuria.Journal of healthcare engineering · 2021Article
- Prototype Development of an Expert System of Computerized Clinical Guidelines for COVID-19 Diagnosis and Management in Saudi Arabia.International journal of environmental research and public health · 2020Article
- Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk.Applied clinical informatics · 2020Article
- Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians.JAMA network open · 2019Article
- The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach.Emergency radiology · 2017Article
- Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer.Applied clinical informatics · 2017Article
- Thinking Together: Modeling Clinical Decision-Support as a Sociotechnical System.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2017Article
- Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center.Journal of general internal medicine · 2016Article
- Development and Validation of Electronic Health Record-based Triggers to Detect Delays in Follow-up of Abnormal Lung Imaging Findings.Radiology · 2015Article
- Prioritization of free-text clinical documents: a novel use of a bayesian classifier.JMIR medical informatics · 2015Article
- Communication breakdowns and diagnostic errors: a radiology perspective.Diagnosis (Berlin, Germany) · 2014Article
- A 2014 medical informatics perspective on clinical decision support systems: do we hit the ceiling of effectiveness?Yearbook of medical informatics · 2014Review
- Diagnostic errors: moving beyond 'no respect' and getting ready for prime time.BMJ quality & safety · 2013Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAbnormal test results do not always receive timely follow-up, even when providers are notified through electronic health record (EHR)-based alerts. High workload, alert fatigue, and other demands on attention disrupt a provider's prospective memory for tasks required to initiate follow-up. Thus, EHR-based tracking and reminding functionalities are needed to improve follow-up.
objectivesThe purpose of this study was to develop a decision-support software prototype enabling individual and system-wide tracking of abnormal test result alerts lacking follow-up, and to conduct formative evaluations, including usability testing.
methodsWe developed a working prototype software system, the Alert Watch And Response Engine (AWARE), to detect abnormal test result alerts lacking documented follow-up, and to present context-specific reminders to providers. Development and testing took place within the VA's EHR and focused on four cancer-related abnormal test results. Design concepts emphasized mitigating the effects of high workload and alert fatigue while being minimally intrusive. We conducted a multifaceted formative evaluation of the software, addressing fit within the larger socio-technical system. Evaluations included usability testing with the prototype and interview questions about organizational and workflow factors. Participants included 23 physicians, 9 clinical information technology specialists, and 8 quality/safety managers.
resultsEvaluation results indicated that our software prototype fit within the technical environment and clinical workflow, and physicians were able to use it successfully. Quality/safety managers reported that the tool would be useful in future quality assurance activities to detect patients who lack documented follow-up. Additionally, we successfully installed the software on the local facility's "test" EHR system, thus demonstrating technical compatibility.
conclusionTo address the factors involved in missed test results, we developed a software prototype to account for technical, usability, organizational, and workflow needs. Our evaluation has shown the feasibility of the prototype as a means of facilitating better follow-up for cancer-related abnormal test results.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.