Improving Direct Notification of Abnormal Test Results via Patient Portals

描述（由申请人提供）：背景：尽管健康信息技术（HIT）可以促进检测结果数据的交流，但仍有7%的电子传输异常实验室检测结果失访。减少随访延迟的一种潜在方法是增加患者获得其测试结果的机会。第2阶段有意义的使用标准鼓励患者参与，并强调为患者提供电子访问其临床信息的重要性。虽然现在患者可以通过安全门户网站获得一些检测结果，但这些工具的使用率总体上仍然很低，并且通过门户网站通知患者异常检测结果的效用尤其不清楚。需要更多的经验知识，HIT如何在改善异常测试结果的沟通和后续工作中发挥作用，以及基于HIT的工具应该具备哪些功能。了解患者对通过门户进行结果通知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：该应用程序的目标是探索和改进如何利用HIT来帮助患者管理异常检测结果的随访。这些目标非常重要，因为未能跟进异常检测结果会导致诊断和治疗延迟，并可能导致患者伤害。为了开发以患者为中心的实践并通过门户网站设计测试结果管理，我们将解决许多影响该领域结果的社会技术变量，包括技术（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、过程和程序）。目的和方法：我们的应用程序是由一个概念模型，假定一组八个社会技术方面，应考虑在HIT干预措施，如通过患者门户网站的测试结果交付。目标1将通过患者门户网站了解患者在收到异常检测结果时的需求、偏好和反应。我们将进行访谈，以通过门户网站识别个人场景和测试结果通知偏好，观察这些测试结果通知场景的门户网站使用情况，并进行焦点小组讨论，以探索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，以满足患者的需求，偏好和通过患者门户网站接收异常检测结果的反应。我们将开发接收和响应异常测试结果通知的复杂或具有挑战性的情况的场景，并使用这些场景，我们将进行“舞台世界”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与创新的方法来理解和改善HIT和电子通信在门诊设置。调查结果将确定患者门户网站的功能要求，并促进患者参与管理适当的测试结果随访。

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.