The American Journal of Medicine
Volume 123, Issue 3 , Pages 238-244 , March 2010

Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?

  • Hardeep Singh, MD, MPH

      Affiliations

    • Houston VA Health Services Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
    • Corresponding Author InformationRequests for reprints should be addressed to Hardeep Singh, MD, MPH, VA Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030
    • ,
  • Eric J. Thomas, MD, MPH

      Affiliations

    • Division of General Medicine, Department of Medicine, University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School at Houston
    • ,
  • Dean F. Sittig, PhD

      Affiliations

    • University of Texas School of Health Information Sciences and the UT-Memorial Hermann Center for Healthcare Quality & Safety, Houston
    • ,
  • Lindsey Wilson, MA

      Affiliations

    • Houston VA Health Services Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
    • ,
  • Donna Espadas, BS

      Affiliations

    • Houston VA Health Services Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
    • ,
  • Myrna M. Khan, PhD, MBA

      Affiliations

    • Houston VA Health Services Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex
    • ,
  • Laura A. Petersen, MD, MPH

      Affiliations

    • Houston VA Health Services Research & Development Center of Excellence, The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex

References 

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  2. Hickner J, Graham DG, Elder NC, et al. Testing process errors and their harms and consequences reported from family medicine practices: a study of the American Academy of Family Physicians National Research Network. Qual Saf Health Care. 2008;17:194–200
  3. Hickner JM, Fernald DH, Harris DM, et al. Issues and initiatives in the testing process in primary care physician offices. Jt Comm J Qual Patient Saf. 2005;31:81–89
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  10. Nepple KG, Joudi FN, Hillis SL, Wahls TL. Prevalence of delayed clinician response to elevated prostate-specific antigen values. Mayo Clin Proc. 2008;83:439–448
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  12. Poon EG, Haas JS, Louise PA, et al. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19:316–323
  13. Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145:488–496
  14. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165:1493–1499
  15. Singh H, Arora HS, Vij MS, et al. Communication outcomes of critical imaging results in a computerized notification system. J Am Med Inform Assoc. 2007;14:459–466
  16. Singh H, Naik A, Rao R, Petersen L. Reducing diagnostic errors through effective communication: harnessing the power of information technology. J Gen Intern Med. 2008;23:489–494
  17. Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol. 2007;25(31):5009–5018
  18. Poon EG, Wang SJ, Gandhi TK, et al. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003;36(1-2):80–91
  19. Singh H, Thomas EJ, Mani S, et al. Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential?. Arch Intern Med. 2009;169:1578–1586
  20. van Walraven C, Naylor CD. Do we know what inappropriate laboratory utilization is? (A systematic review of laboratory clinical audits). JAMA. 1998;280:550–558
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  22. Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. 2006;15(Suppl 1):i50–i58
  23. Kushniruk AW, Patel VL. Cognitive evaluation of decision making processes and assessment of information technology in medicine. Int J Med Inform. 1998;51(2-3):83–90
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  26. van Walraven C, Raymond M. Population-based study of repeat laboratory testing. Clin Chem. 2003;49:1997–2005

 Funding: The study was supported by an NIH K23 career development award (K23CA125585) to Dr. Singh, the VA National Center of Patient Safety, Agency for Health Care Research and Quality Health Services Research Demonstration and Dissemination Grant (R18 HS17244-02) to Dr. Thomas, and in part by the Houston VA Health Services Research & Development Center of Excellence (HFP90-020). These sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

 Conflict of Interest: The authors have no conflicts of interest to report.

 Authorship: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

 The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

PII: S0002-9343(09)00956-5

doi: 10.1016/j.amjmed.2009.07.027

The American Journal of Medicine
Volume 123, Issue 3 , Pages 238-244 , March 2010

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