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Effectiveness of an Electronic Health Record-based Intervention to Improve Follow-up of Abnormal Pathology Results: A Retrospective Record Analysis

Laxmisan, Archana MD, MA*,†; Sittig, Dean F. PhD; Pietz, Kenneth PhD*,†; Espadas, Donna BS*,†; Krishnan, Bhuvaneswari MD†,§; Singh, Hardeep MD, MPH*,†

doi: 10.1097/MLR.0b013e31825f6619
Brief Report

Background and Objective: On March 11, 2009, the Veterans Health Administration (VA) implemented an electronic health record (EHR)-based intervention that required all pathology results to be transmitted to ordering providers by mandatory automated notifications. We examined the impact of this intervention on improving follow-up of abnormal outpatient pathology results.

Research Design and Subjects: We extracted pathology reports from the EHR of 2 VA sites. From 16,738 preintervention and 17,305 postintervention reports between 09/01/2008 and 09/30/2009, we randomly selected about 5% and evaluated follow-up outcomes using a standardized chart review instrument. Documented responses to the alerted report (eg, ordering follow-up tests or referrals, notifying patients, and prescribing/changing treatment) were recorded.

Measures: Primary outcome measures included proportion of timely follow-up responses (within 30 d) and median time to direct response for abnormal reports.

Results: Of 816 preintervention and 798 postintervention reports reviewed, 666 (81.6%) and 688 (86.2%) were abnormal. Overall, there was no apparent intervention effect on timely follow-up (69% vs. 67.1%; P=0.4) or median time to direct response (8 vs. 8 d; P=0.7). However, logistic regression uncovered a significant intervention effect (preintervention odds ratio, 0.7; 95% confidence interval, 0.5–1.0) after accounting for site-specific differences in follow-up, with a lower likelihood of timely follow-up at one site (odds ratio, 0.4; 95% confidence interval, 0.2–0.7).

Conclusions: An electronic intervention to improve test result follow-up at 2 VA institutions using the same EHR was found effective only after accounting for certain local contextual factors. Aggregating the effect of EHR interventions across different institutions and EHRs without controlling for contextual factors might underestimate their potential benefits.

*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

Baylor College of Medicine

University of Texas School of Biomedical Informatics, the UT-Memorial Hermann Center for Healthcare Quality & Safety

§Section of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

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 and in part by the Houston VA HSR&D 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.

A.L. and K.P. 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 authors declare no conflict of interest.

Reprints: Archana Laxmisan, MD, MA, Houston VA Health Services Research and Development Center of Excellence, Mail Stop 152, 2002 Holcombe Boulevard, Houston, TX 77030. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.