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Published online December 16, 2008
PEDIATRICS Vol. 123 Supplement January 2009, pp. S85-S91 (doi:10.1542/peds.2008-1755G)
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SUPPLEMENT ARTICLE


Electronic Results Management in Pediatric Ambulatory Care: Qualitative Assessment

Timothy G. Ferris, MD, MPHa,b,c, Sarah A. Johnson, BAa, John Patrick T. Co, MD, MPHb,c, Meghan Backus, BAa, James Perrin, MDb,c, David W. Bates, MD, ScDc,d, Eric G. Poon, MD, MPHa,c,d

a Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
b Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Massachusetts
c Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
d Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

BACKGROUND. Electronic results management may improve the reliability and efficiency of test results management, but few studies have investigated this topic in pediatrics.

METHODS. We conducted semi-structured, key informant interviews before and after implementation of electronic results management at 8 pediatric ambulatory care practices. We also surveyed all pediatricians at 18 practices (10 additional practices). All practices were members of Partners Healthcare and had been using an electronic health record when they were offered electronic results management. We assessed baseline processes for results management, barriers to electronic results management adoption, and the perceived impact of electronic results management on quality, efficiency, and provider satisfaction.

RESULTS. From interviews, we found a range of processes in place to manage test results, but all practices reported losing some results and no practice tracked all test results from the time of ordering to parent/patient notification. Practices that fully adopted electronic results management reported gains in efficiency, reliability, timeliness, and provider satisfaction, whereas some partial adopters reported decreased efficiency and increased risk of lost test results. Barriers to electronic results management adoption included lack of inclusion of all ordered tests in the electronic results management system, user interface design issues, and lack of sufficient pediatric customization. Survey results (response rate: 62%) indicated that pediatricians thought electronic results management improved the quality and efficiency of care, with 72% of pediatricians reporting safer care and 63% reporting more-effective care.

CONCLUSIONS. We found that pediatric practices have room for improvement in the management of test results, and electronic results management may be an effective method for improving the efficiency and safety of test results management. However, partial adoption of electronic results management may decrease efficiency and pose a threat to patient safety.

Key Words: clinical laboratory information systems • ambulatory care information systems • quality of health care

Abbreviations: ERM—electronic results management • EHR—electronic health record

Accepted Sep 11, 2008.


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