Patient testing is vital for primary care and serves as a gateway to specialty healthcare. Patient safety is worsened when testing orders (e.g., laboratory, imaging orders) are not tracked, results are lost, or abnormal results lack patient notification and follow-up. Non-standardized testing management reduces resilience; affects clinical outcomes; and increases errors, costs, workload, and delays.
To address the need for testing management improvements, this research followed four phases in six objectives: (1) In Phase I initial survey, assess perceptions, attitudes, and behaviors of practicing healthcare clinicians and administrators about testing, safety, and technology; (2) In Phase II system design, design a low-cost system prototype that manages primary care testing processes for individual patients, supports safety and resilience, and measures overall clinic testing performance for continuous improvement efforts; (3) In Phase III laboratory experiment, evaluate system prototype for effectiveness in managing testing management processes, including test ordering, results review, notification, and tracking; (4) In Phase III, evaluate effectiveness of technology specifically designed to enforce, support, nurture, and measure safety- including individual safety awareness, attitudes, actions, resilience, and safety culture; (5) In Phase III, evaluate effectiveness of the testing management system prototype for increasing understanding of overall clinic testing performance; (6)In Phase IV clinical review, evaluate a revised prototype with primary care clinicians for its perceived effectiveness and potential for process, safety, and performance improvements.
This research resulted in a test management system prototype that was effective in managing and standardizing testing processes; showed effectiveness for some aspects of safety, situation awareness, and resilience; and was effective in developing user understanding of clinic performance in testing processes. This system can be used for future product development.
Based on theories of resilience, organizational and safety culture, systems safety, and situation awareness, this research also contributes to an increased understanding of requirements to design health information technology that enforces, supports, nurtures, and measures safety.