Primary Care

Primary care doctors prefer additional medical record information when making decisions about patient test results

With increased demands on their time, primary care physicians (PCPs) often must make decisions about patient test results on the fly, without complete patient data. In fact, studies show that follow up of abnormal diagnostic test results is one of the most problematic safety issues in outpatient practice. A preliminary study shows that automatically adding information from a patient's electronic medical records can add to the usefulness of test results sent to the patient's PCP. Nine surveyed PCPs found that enhanced laboratory reports (ELRs)—which include previous related test results, medication prescriptions, information from recent primary care visits, and computer-generated reminders related to the type of test done—were well organized and easy to interpret. The ELRs included a median of 11 additional report elements. The PCPs rated the elements an average of 3.2 to 4.3 on a 5-point Likert scale (from 1, least valuable, to 5, most valuable). In fact, the physicians preferred the ELRs to standard lab reports, giving the ELRs a rating of 3.8 points.

J. Marc Overhage, M.D., Ph.D., and his colleagues relied on information stored in a regional Health Information Exchange, the Indiana Network for Patient Care (INPC), to provide the additional data elements. The ELR processor in the preliminary study started with a list of 10 common laboratory tests to enhance, which were chosen because they typically require historical data for medical decisionmaking. For each test selected for enhancement, the researchers created a set of relevant lab test and medication associations. A third component of the enhanced report was a history of visits to providers within the INPC. Finally, a set of clinical reminders was created to help guide clinicians as they interpreted the ELRs and made medical decisions.

The ELR processor created a new message that appended the additional information to the original lab result, and delivered the ELR to the identified PCP via the special application. The researchers plan future studies of ELRs that will include a larger panel of evaluating physicians, increased number and complexity of rules that generate reminders, and the impact of ELRs on quality of care. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-04-0015).

More details are in "Enhancing laboratory report contents to improve outpatient management of test results," by Kevin C. Chang, M.D., Dr. Overhage, Siu L. Hui, Ph.D, and others in the January/February 2010, Journal of the American Medical Informatics Association 17(1), pp. 99-103.

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