REDUCING MISSED
LABORATORY TEST RESULTS
Sureyya Tarkan,
Catherine Plaisant, Ben Shneiderman
UMD Department of Computer Science & HCIL
sureyya@cs.umd.edu
http://www.cs.umd.edu/hcil/sharp/
‘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)

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TEST PROCESS STEPS
1.
Pre-analytic
Ordering the test
b. Implementing the test
a.
2.
Analytic
a.
3.
Performing the test
Post-analytic
Specimen
lost
Patient &
Specimen Physician
damaged during
transport
Lab
Patient
Specimen
technician
doesn’t go
mislabeled in
office
Reporting results to the clinician
PhysicianResults misplaced
b. Responding to the results
c. Notifying the patients of the results
NoNurse
documentation
on record
d. Following-up to ensure the patient took the
appropriate action based on test results
a.
Provider on
vacation
2
MOTIVATION: PACKAGE TRACKING
Clear expectation
Constant feedback
3
Explicit responsibility
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
4
SIMPLE MODEL: GENERIC TEST PROCESS
ACTOR: Patient
TASK: Get Test Done
START: 0
END: 6
UNIT: days
ACTOR: Provider
TASK: Analyze Result
END: 1
UNIT: days
ACTION: Access Report,
Inform Patient, Schedule
Visit, Repeat Test, Order
New Test…
5
EXTENDED MODEL: LABORATORY TEST
Schedule
Exam &
Go to
Appointmen
t (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
6
MODELING COMPOUND TESTS
EXAMPLE: STREP THROAT
Rapid Test:
Office Test
Strep Throat
(1 hour)
Culture:
Laboratory Test
(1 week)
7
MULTI-STEP TASK ALERTING, REMINDING,
TRACKING (MSTART) PROTOTYPE
8
TRACK
June 27, 2016
9
GENERATING ACTOR ACTION SHEETS:
RESULT REVIEW
10
ORDER
June 27, 2016
11
RETROSPECTIVE ANALYSIS
12
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: sureyya@cs.umd.edu
Website: http://www.cs.umd.edu/hcil/sharp/
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