Open Access Highly Accessed Research article

Understanding the management of electronic test result notifications in the outpatient setting

Sylvia J Hysong1*, Mona K Sawhney1, Lindsey Wilson1, Dean F Sittig2, Adol Esquivel3, Simran Singh4 and Hardeep Singh1

Author Affiliations

1 Houston VA Health Sciences 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, Texas, USA

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

3 St. Luke's Episcopal Health System, Houston, Texas, USA

4 Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA

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BMC Medical Informatics and Decision Making 2011, 11:22  doi:10.1186/1472-6947-11-22

Published: 12 April 2011



Notifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.


We conducted a qualitative study consisting of six 6-8 member focus groups (N = 44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow.


Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification.


Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.

Decision Support Systems; Clinical; Automated notification; diagnostic errors; abnormal diagnostic test results; Medical Records Systems; Computerized; patient follow-up; patient safety; health information technology; communication; primary care