The use of health information technology in the follow-up of patient test results: an exploration of the experiences and views of primary care staff in the North East of England

Abstract

Background
Computerisation in general practices in the UK over the last 30 years has enabled paperless clinical record keeping but the process of ordering tests and receiving results electronically from hospital systems has been a relatively recent development. The Integrated Clinical Environment System (ICE) provides an electronic link between general practices and hospital-based facilities, facilitating the timely transfer of test results across healthcare boundaries. Whilst the existing literature covers the technical aspects of such systems, there is a paucity of information about how these systems function in real life and what views healthcare staff have of using them.
Aims and Objectives
This research sought to ascertain the experiences and views of health care staff in general practice about their use of health information technology (HIT) systems for the ordering, processing and follow-up of test results. The research described the test ordering processes and the subsequent actions taken by healthcare professionals. It provided an understanding of different staff roles in this process, including what obstacles GPs and administrative staff faced and their views on the possible subsequent impact these obstacles had on patient care. The human element in the process of requesting and dealing with test results has not been previously described in detail.
Methodology
The programme of work comprises, in the first section, a narrative and systematic review of the literature, initially from the UK and then, because of a paucity of data, the global setting, on using HIT to order and act on test results. This was followed by a description of the established Donabedian model for evaluating healthcare processes through the stages of structure, process and outcome, with a description of how these components applied to this research.
The third section of the thesis consisted of empirical qualitative research project involving semi-structured interviews with 18 staff members from 13 general practices within the North East of England, to ascertain and explore their experiences, views and perceptions around using HIT systems for the follow-up of test results. A conceptual framework was generated by which these data were labelled and sorted. The analysis process involved identifying recurring themes and concepts.
Results
The reviews indicated that users found the HIT systems easy to use and felt that these systems improved their efficiency compared with the previous paper-based systems, which was confirmed in this study.
A new finding, reflecting aspects of the literature, was that results’ management was also perceived to be associated with increased workload, sometimes due to receiving multiple warning alerts about abnormal findings and because of results received from tests done elsewhere.
A further, new finding, was the blurring of responsibility and duties about who should review, interpret and act on certain test results received. This task was sometimes left to administrative staff, whose role was to file ‘normal’ results but often found themselves in a position of not knowing whether such results had clinical significance. This factor appeared to be related to GP workload and the delegation of tasks. Participants also felt that the numbers of tests ordered and received had increased, an issue highlighted recently in the literature. There also appeared to be an increasing level of dis-continuity in the clinical care provided in practices, related in part to the use of locum and sessional doctors. Tests ordered were not necessarily designated for follow-up by a specific doctor. These factors may also be contributing to the increasing number of tests ordered.
Conclusions and Discussion
This study found that whilst the new HIT systems for tests have been associated with ease of use and efficiency in the transfer and availability of results, there appears to be a number of challenges in processing and actioning these results. Applying the Donabedian model for evaluating healthcare processes through the stages of structure, process and outcome shows how the components of the differing procedures have potential drawbacks and could contribute to compromised patient care. This is largely related to the changing structures of general practice whereby continuity of care can be a problem. There appeared to be no standardised procedures for dealing with tests and a standardised approach might be a necessary way forward.
This work revealed the importance of human factors in the structure and process of tests results’ management, and how clarification of responsibilities and maintenance of continuity of care are crucial elements in delivering high quality care.