Person:

Orav, Endel

Background: Few reliable and efficient systems sup- port the communication of test results to outpatients, and this may lead to patient dissatisfaction with test result communication. The objective of this study was to assess the impact of physicians’ use of a test results management tool embedded in an electronic health record on patient satisfaction with test result communication.

Methods: A prospective, cluster-randomized, con- trolled trial of 570 patient encounters in 26 outpatient primary care practices was performed from December 1, 2002, to April 31, 2005. Physicians in the intervention practices were trained and given access to a physician test results management tool with imbedded patient notification functions to evaluate whether patient satisfaction with communication of test results ordered by the primary care provider was improved. Patient satisfaction surveys were conducted by telephone after the patient underwent the test and were administered before and after the intervention in both arms. Results: The survey response rate after successful patient contact was 74.2% (570/768). After adjusting for patient age, sex, race, socioeconomic status, and insurance type, the intervention significantly increased patient satisfaction with test results communication (odds ratio, 2.35; 95% confidence interval, 1.05-5.25; P=.03). In addition, patients in the postintervention group were more satisfied with information given them for medical treatments and conditions regarding their results (odds ratio, 3.45; 95% confidence interval, 1.30-9.17; P = .02).

Conclusion: An automated test results management system can improve patient satisfaction with communication of test results ordered by their primary care provider and can improve patient satisfaction with the communication of information regarding their condition and treatment plans.

Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit documen- tation to laboratory test ordering, but little is known about physicians’ actual use of these functions. Methods: We surveyed a random sample of 1884 phy- sicians in Massachusetts by mail and assessed availabil- ity and use of EHR functions, predictors of use, and the relationships between EHR use and physicians’ percep- tions of medical practice. Results: A total of 1345 physicians responded to the sur- vey (71.4% response rate), and 387 (28.8%) reported that their practice had adopted EHRs. More than 80% of phy- sicians with EHRs reported having the ability to view labo- ratory reports (84.8%) and document visits electroni- cally (84.0%), but considerably fewer reported being able to order laboratory tests electronically (46.8%) or trans- mit prescriptions to a pharmacy electronically (44.7%). Fewer than half of the physicians who had systems with clinical decision support, transmittal of electronic pre- scriptions, and radiology order entry actually used these functions most or all of the time. Compared with phy- sicians who had not adopted EHRs, EHR users reported more positive views of the effects of computers on health care; there were no significant differences in these atti- tudes between high and low users of EHRs. Overall, about 1 in 4 physicians reported dissatisfaction with medical practice; there was no difference in this measure by EHR adoption or use. Conclusions: There is considerable variability in the func- tions available in EHRs and in the extent to which phy- sicians use them. Future work should emphasize fac- tors that affect the use of available functions.