In a new survey, nearly 30 percent of primary care practitioners said they missed test results sent via an electronic health record notification system.
MONDAY, March 4, 2013 — Patients might assume that their doctors are keeping close track of their health records, but a new survey shows a large percentage of physicians are missing important electronic alerts, possibly due to the fact they receive too many notifications to reliably keep track of.
Researchers surveyed 2,590 primary care practitioners in the Veterans Affairs (VA) system from June to November 2010. In the survey, almost 30 percent of the doctors reported missing test results posted through an electronic health records (EHR) system.
The survey found that the median number of alerts the doctors received was 63 per day. Eighty-six percent of the doctors perceived the number of alerts to be excessive, and almost 70 percent reported they were receiving more alerts than they could effectively manage, according to a research letter by Hardeep Singh, MD, MPH of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, published online in the Journal of the American Medical Association.
This number didn’t surprise Tejal Gandhi, MD, MPH, associate professor of medicine at Harvard Medical School, who was not involved in the survey.
“I think we have a long way to go to figure out the best ways to alert providers about important test results,” Dr. Gandhi says.
If doctors are not receiving timely information about medical tests, it could potentially mean serious consequences for all patients, she adds, not just those in the VA system.
“There could be serious consequences if it is an important test result and the doctor misses it — for example, leading to a missed or delayed diagnosis of some condition," says Gandhi.
She mentions workload issues, over-alerting, and useability as some of the factors that could be contributing to doctors missing test results.
“Doctors are getting so many alerts it's interrupting their workflow, and they may be blowing by them because they’re trying to do something else,” Gandhi says.
When it comes to useability, according to Gandhi, “In general, health records [systems] don’t do a great job of making sure important things stand out more than lesser important things. That contributes to missing important alerts."
She suggests different ways of triaging alerts could help physicians more easily flag the ones they know they need to look at. “There may be some better strategies, for example, [assigning] one person whose job it is to look at these alerts might be better than having doctors have to manage these alerts in addition to everything else that goes on in their clinic,” she says.
Overall, Electronic Notifications Better Than Paper
Despite the problems with EHRs, Gandhi says electronic records and notifications are better than the paper systems doctors used in the past (and that some still use) in which papers could get lost very easily.
"This is an interesting time because it's right when so many people are adopting these electronic health records. It’s an early time for many hospitals to adopt these systems, so I’m hopeful things will get better as more studies come out and more vendors work to improve their products," she says.
Diana Warner, MS, RHIA, CHPS, FAHIMA, Director of HIM Practice Excellence at the American Health Information Management Association, helped roll out an EHR system at the University of Minnesota Physicians. She said physicians were frustrated with the number of alerts they got at first, so she helped manage which alerts the doctors got and which ones could be turned off.
For those who work in hospitals, Warner recommends putting together a clinical support group to look at how alerts are set up, and change the settings to suit the practice or contact the EHR vendor to tailor alerts to the specialty or even to specific physicians.
“One thing hospitals should do is have evidence-based alerts. They need to make sure there is evidence behind the need to have certain types of alerts,” Warner says.
How Patients Can Protect Themselves
EHR systems have backup in some cases, since some labs still call patients in situations where it's urgent that they get certain test results. But in many cases, patients can’t count on labs, pharmacies, or doctors to stay on top of their medical tests and history. The best thing patients can do for themselves is to be engaged in their own healthcare. If you have a medical test, call your doctor's office to get the results if you don't hear from them within a reasonable time.
"They [patients] need to understand what their allergies are, what medications they are taking, and if they are getting a new medication, what it’s for or how it interacts with other medications. You can’t rely on your pharmacy or your primary care physician,” says Warner.
“If you’re unclear about anything, ask. Don’t just assume your doctor knows what they are doing. They are human too, whether it’s on paper or in the electronic world, patients still need to take the reins and be in charge of their own healthcare.”
CREDIT: Rick Gomez/Corbis