Improving Direct Notification of Abnormal Test Results via Patient Portals

背景：尽管卫生信息技术（HIT）可以促进检测结果数据的交流，但7%的电子传输的异常实验室检测结果仍丢失在随访中。减轻随访延误的一个潜在方法是增加患者获得检测结果的机会。第二阶段有意义的使用标准激励患者参与，并强调为患者提供电子访问其临床信息的重要性。尽管现在患者可以通过安全门户获得一些检测结果，但总体而言，这些工具的使用率仍然很低，通过门户向患者通报异常检测结果的效用尤其不清楚。HIT如何在改善异常测试结果的沟通和跟踪方面发挥作用，以及基于HIT的工具应该具备哪些特性，需要更多的经验知识。了解患者对通过门户网站通知结果的需求和偏好对于优化通知系统的设计和实施至关重要。目的：本应用程序的目的是探索和改进如何利用HIT来帮助患者管理异常检查结果的随访。这些目标非常重要，因为未能对异常检测结果进行随访会导致诊断和治疗的延误，并可能对患者造成伤害。为了通过门户开发以患者为中心的实践和测试结果管理设计，我们将处理影响该领域结果的许多社会技术变量，包括技术因素（例如，软件，临床内容和用户界面设计）以及非技术因素（例如，人际沟通，临床工作流程，流程和程序）。目的和方法：我们的应用程序以一个概念模型为指导，该模型假设了一组八个社会技术维度，这些维度应该在HIT干预措施中考虑，例如通过患者门户网站提供测试结果。Aim 1将引出患者在通过患者门户网站收到异常检测结果时的需求、偏好和反应。我们将进行访谈，以确定通过门户的个人场景和测试结果通知偏好，观察门户对这些测试结果通知场景的使用情况，并进行焦点小组讨论，以探讨影响测试结果通知使用的社会技术因素。在目标2中，我们将开发功能需求和社会技术解决方案，以解决患者通过患者门户接收异常检测结果的需求、偏好和反应。我们将开发复杂或具有挑战性的场景，接收和响应异常测试结果通知，并使用这些场景，我们将进行“阶段世界”认知任务分析研究。拟议的工作将利用我们的多学科团队的经验，以创新的方法来理解和改善门诊环境中的HIT和电子通信。研究结果将确定患者门户的功能需求，并促进患者参与适当的检测结果随访管理。

DESCRIPTION (provided by applicant): Background: Although health information technology (HIT) can facilitate communication of test result data, 7% of electronically transmitted abnormal laboratory test results are nevertheless lost to follow-up. One potential method to mitigate delays in follow-up is to increase patients' access to their test results. Stage 2 meaningful use criteria incentivize patient engagement and highlight the importance of providing patients with electronic access to their clinical information. Although some test results are now available to patients through secure portals, the use of these tools remains low overall, and the utility of patient notification via portals for abnormal test results is especially unclear. More empirical knowledge is needed about how HIT could play a role in improving abnormal test result communication and follow-up, and what features HIT-based tools should possess. Knowledge of patients' needs and preferences for results notification via portals is essential to optimizing design and implementation of notification systems. Objectives: The goal of this application is to explore and improve how HIT can be leveraged to help patients manage follow-up of abnormal test results. These goals are highly significant because failures to follow-up abnormal test results lead to delays in diagnosis and treatment and may result in patient harm. To develop patient-centered practices and design for test result management via portals, we will address many socio- technical variables that influence outcomes in this area, including technological (e.g., software, clinical content and user interface design) as well as non-technological factors (e.g., inter-personal communication, clinical workflows, processes, and procedures). Aims and Methods: Our application is guided by a conceptual model that posits a set of eight socio-technical dimensions that should be considered in HIT interventions such as test results delivery via patient portals. Aim 1 will elicit patients' needs, preferences and responses when receiving abnormal test results via patient portals. We will conduct interviews to identify individual scenarios and test result notification preferences via portals, observe portal use for these test results notification scenarios, and conduct focus groups to explore socio- technical factors that affect the use of test result notification. In Aim 2, we will develop functional requirements and socio-technical solutions to address patients' needs, preferences and responses to receiving abnormal test results via patient portals. We will develop scenarios of complex or challenging situations of receiving and responding to abnormal test result notifications and using these scenarios, we will conduct a "staged world" Cognitive Task Analysis study. The proposed work will leverage our multidisciplinary team's experience with innovative approaches to understanding and improving HIT and electronic communication in outpatient settings. Findings will identify functional requirements for patient portals and facilitate patients' involvement in management of appropriate test result follow-up.