1. Reducing Missed Laboratory Test Results
Sureyya Tarkan,
Catherine Plaisant, Ben Shneiderman
UMD Department of Computer Science & HCIL

2. ‘Missed Results’ Problem
Mishandling of abnormal results & no follow-up (Wahls, 2007)
Most common missing information: test results (Dovey, 2002)
Delay in care, time/financial loss, pain/suffering, adverse clinical consequence (Hickner, 2008)

3. Test Process Steps Pre-analytic Analytic Post-analytic
Ordering the test
Implementing the test
Analytic
Performing the test
Post-analytic
Reporting results to the clinician
Responding to the results
Notifying the patients of the results
Following-up to ensure the patient took the appropriate action based on test results
Specimen lost
Patient & Physician
Specimen damaged during transport
Lab technician
Patient doesn’t go
Specimen mislabeled in office
Physician
Results misplaced
No documentation on record
Nurse
Provider on vacation

4. Motivation: Package tracking
Clear expectation
Constant feedback
Explicit responsibility

5. Approach for Reducing Missed Laboratory Results
Model lab tracking processes
Assign temporal responsibility
Derive user interface from processes
From order time to until all follow-up actions are taken
Support actor actions as part of tracking
Provide retrospective analyses to identify common problems

6. Simple Model: Generic Test Process
ACTOR: Patient
TASK: Get Test Done
START: 0
END: 6
UNIT: days
ACTOR: Provider
TASK: Analyze Result
END: 1
ACTION: Access Report, Inform Patient, Schedule Visit, Repeat Test, Order New Test…

7. Extended Model: Laboratory Test
Schedule Exam & Go to Appointment (4 days)
Accept Patient (1 hour)
Confirm Appointment
Update Patient Info?
Draw & Store Sample (1 hour)
Prepare Equipment
Send Sample (20 hours)
Ship with Carrier or Transport by self
Examine Specimen & Record Results (1 day)
Access Patient Sample
Conduct Test
Write Results

8. Modeling Compound Tests Example: Strep Throat
Rapid Test: Office Test
(1 hour)
Culture: Laboratory Test
(1 week)

9. Multi-Step Task Alerting, Reminding, Tracking (MSTART) Prototype

10. Track
November 14, 2018

11. Generating Actor Action Sheets: Result Review

12. Order
November 14, 2018

13. Retrospective Analysis

14. Conclusion: Guidelines
Make temporal responsibility visible
Tracking should show what is pending
(and how much time has passed since last action)
Prioritize late and critical (abnormal) entries
Integrate review of results with possible actor actions from within same screen
Retrospective analysis improves accountability
Acknowledgments
Zach Hettinger, Daniel Murphy, Archana Laxmisan, Hardeep Singh, Dean Sittig
Strategic Health-IT Advanced Research Projects (SHARP)
Contact:
Website: