Louis Raymond
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Abstract
Important problems remain regarding the efficiency and quality of laboratory testing in primary care. In view of this, a significant function of electronic medical record (EMR) systems is to enable the practice of laboratory medicine by primary care physicians. The present study aims to deepen our understanding of the nature and extent of physicians' use of EMR and other laboratory information exchange systems for patient management and care within the laboratory testing process. We conducted a survey of 684 Canadian family physicians. Results indicate that physicians use 84 percent of the laboratory functionalities available in their EMR system. The two most important impacts are the ability to gain time in the post-analytical phase and to take faster action in this same phase as they follow-up on their patients' test results. Physicians who perceive to benefit most from their EMR use are those who make the most extensive use of their system. Extended use of an EMR system allows primary care physicians to better ascertain and monitor the health status of their patients, verify their diagnosis assumptions, and, if their system includes a clinical decision support module, apply evidence-based practices in laboratory medicine.
- Babbie, E. (2013). The practice of social research. Belmont, CA, USA: Wadsworth.Google Scholar
- Balogh, E. P., Miller, B. T., & Ball, J. R. (2015). Improving diagnosis in health care. National Academy of Medicine, Washington, DC, USA: National Academies Press.Google Scholar
- Beasley, J. W., Wetterneck, T. B., Temte, J., Lapin, J. A., Smith, P., Rivera-Rodriguez, A. J., et al. (2011). Information chaos in primary care: Implications for physician performance and patient safety. Journal of the American Board of Family Medicine, 24(6), 745--751.Google ScholarCross Ref
- Blaya, J. A., Shin, S., Contreras, C., Yale, G., Suarez, C., Asencios, L., et al. (2011). Full impact of laboratory information system requires direct use by clinical staff: Cluster randomized controlled trial. Journal of the American Medical Informatics Association, 18(1), 11--16.Google ScholarCross Ref
- Broemeling, A. M., Watson, D. E., & Prebtani, F. (2008). Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: Implications for policy and practice. Healthcare Quarterly, 11(3), 70--76.Google ScholarCross Ref
- Burke, D. E., Wang, B. B. L., Wan, T. T. H., & Diana, M. L. (2002). Exploring hospitals' adoption of information technology. Journal of Medical Systems, 26(4), 349--355.Google ScholarDigital Library
- Burton-Jones, A., & Grange, C. (2013). From use to effective use: A representation theory perspective. Information Systems Research, 24(3), 632--658.Google ScholarCross Ref
- Burton-Jones, A., & Volkoff, O. (2017). How can we contextualize theories of effective use? A demonstration in the context of community-care electronic health records. Information Systems Research, 28(3), 468--489.Google ScholarDigital Library
- Casalino, L. P., Dunham, D., Chin, M. H., Bielang, R., Kistner, E. O., et al. (2009). Frequency of failure to inform patients of clinically significant outpatient test results. Archives of Internal Medicine, 169(12), 1123--1129.Google ScholarCross Ref
- Delvaux, N., De Sutter, A., Van de Velde, S., Ramaekers, D., Fieuws, S., & Aertgeerts, B. (2017). Electronic laboratory medicine ordering with evidence-based order sets in primary care (ELMO study): Protocol for a cluster randomised trial. Implementation Science, 12(147), 1--8.Google Scholar
- Dullabh, P., & Moiduddin, A. (2008). Electronic exchange of clinical laboratory information: Issues and opportunities. Office of the Assistant Secretary for Planning and Education (ASPE), Department of Health & Human Services, USA. https://aspe.hhs.gov/report/electronic-exchange-clinical-laboratory-information-issues-and-opportunities. [accessed on August 22, 2018].Google Scholar
- Elder, N. C., Graham, D., Brandt, E., Dovey, S., Phillips, R., Ledwith, J., et al. (2006). The testing process in family medicine: Problems, solutions and barriers as seen by physicians and their staff: A study of the American Academy of Family Physicians' National Research Network. Journal of Patient Safety, 2(1), 25--32.Google Scholar
- Elder. N. C., Hickner, J., & Graham, D. (2008). Quality and safety in outpatient laboratory testing. Clinics in Laboratory Medicine, 28(2), 295--303.Google ScholarCross Ref
- Elder, N. C., McEwen, T., Flach, J., Gallimore, J., & Pallerla, H. (2010). The management of test results in primary care: Does an electronic medical record make a difference? Family Medicine, 42(5), 327--333.Google Scholar
- Feldstein, A. C., Smith, D. H., Perrin, N., et al. (2006). Improved therapeutic monitoring with several interventions: A randomized trial. Archives of Internal Medicine, 166(17), 1848--1854.Google ScholarCross Ref
- Fernald, D., Hamer, M., James, K., Tutt, B., & West, D. (2015). Launching a laboratory testing process quality improvement toolkit: From the shared networks of Colorado ambulatory practices and partners (SNOCAP). Journal of the American Board of Family Medicine, 28(5), 576--583.Google ScholarCross Ref
- Fischer, S., Tjia, J., Reed, G., Peterson, D., Gurwitz, J., & Field, T. (2014). Factors associated with ordering laboratory monitoring of high-risk medications. Journal of General Internal Medicine, 29(12), 1589--1598.Google ScholarCross Ref
- Gelbard, R., Goldman, O., & Spiegler, I. (2007). Investigating diversity of clustering methods: An empirical comparison. Data & Knowledge Engineering, 63(1), 155--166.Google ScholarDigital Library
- Giokas, D. (2004). Towards a national interoperable electronic health record (EHR) solution. Studies in Health Technology and Informatics, 115, 108--140.Google Scholar
- Hickner, J. M., Fernald, D. H., Harris, D. M., Poon, E. G., Elder, N. C., & Mold, J. W. (2005). Issues and initiatives in the testing process in primary care physician offices. Joint Commission Journal on Quality and Patient Safety, 31(2), 81--89.Google ScholarCross Ref
- Hickner, J. M., Graham, D. G., Elder, N. C., Brandt, E., Emsermann, C. B., Dovey, S., & Phillips, R. (2008). Testing process errors and their harms and consequences reported from family medicine practices: A study of the American Academy of Family Physicians National Research Network. Quality and Safety in Health Care, 17(3), 194--200.Google ScholarCross Ref
- Hickner, J. M., Thompson, P. J., Wilkinson, T., et al. (2014). Primary care physicians' challenges in ordering clinical laboratory tests and interpreting results. Journal of the American Board of Family Medicine, 27(2), 268--274.Google ScholarCross Ref
- Hsieh, J. J. P. A., & Wang. W. (2007). Explaining employees' extended use of complex information systems. European Journal of Information Systems, 16(3), 216--227.Google ScholarCross Ref
- Hurtz, G. M., & Donovan, J. J. (2000). Personality and job performance: The big five revisited. Journal of Applied Psychology, 85(6), 869--879.Google ScholarCross Ref
- Hyppönen, H., Reponen, J., Lääveri, T., & Kaipio, J. (2014). User experiences with different regional health information exchange systems in Finland. International Journal of Medical Informatics, 83(1), 1--18.Google ScholarCross Ref
- Jaana, M., Ward, M. M., Paré, G., & Sicotte, C. (2006). Antecedents of clinical information technology sophistication in hospitals. Health Care Management Review, 31(4), 289--299.Google ScholarCross Ref
- Kelley, K., Clark, B., Brown, V., & Sitzia, J. (2003). Good practice in the conduct and reporting of survey research. International Journal for Quality in Health Care, 15(3), 261--266.Google ScholarCross Ref
- Kreuter, J. M., & Basch, P. (2007). A clinician-centric medical results viewer. Health Management Technology, 28(2), 56--60.Google Scholar
- Litchfield, I. J., Bentham, L. M., Lilford, R. J., & Greenfield, S. M. (2014). Test result communication in primary care: Clinical and office staff perspectives. Family Practice, 31(5), 592--597.Google ScholarCross Ref
- Lundberg, G. D. (1981). Acting on significant laboratory results. Journal of the American Medical Association, 245(17), 1762--1763.Google ScholarCross Ref
- Maillet, É., Paré, G., Currie, L. M., Raymond, R., Ortiz de Guinea, A., Trudel, M. C., & Marsan, J. (2018). Laboratory testing in primary care: A systematic review of health IT impacts. International Journal of Medical Informatics, 116(8), 52--69.Google ScholarCross Ref
- Marchand, M., & Raymond, L. (2017). Characterizing, explaining and valuing the effective use of an IT artefact: A field study of performance management information systems in SMEs. Proceedings of the 50th Hawaii International Conference on System Sciences, 5027--5036.Google ScholarCross Ref
- Marques, M. B., Hickner, J., Thompson, P. J., & Taylor, J. (2014). Primary care physicians and the laboratory: Now and the future. American Journal of Clinical Pathology, 142(6), 738--740.Google ScholarCross Ref
- Maruping, L. M., & Magni, M. (2012). What's the weather like? The effect of team learning climate, empowerment climate, and gender on individuals' technology exploration and use. Journal of Management Information Systems, 29(1), 79--114.Google ScholarDigital Library
- Murff, H. J., Gandhi, T. K., Karson, A. K., Mort, E. A., Poon, E. G., Wang, S. J., et al. (2003). Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems. International Journal of Medical Informatics, 71(2--3), 137--149.Google Scholar
- Myers, J. J., Koester, K. A., Chakravarty, D., Pearson, C., Maiorana, A., Shade, S. B., & Steward, W. T. (2012). Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings. International Journal of Medical Informatics, 81(10), 21--29.Google ScholarCross Ref
- Norman, G. R., & Eva, K. W. (2010). Diagnostic error and clinical reasoning. Medical Education, 44(1), 94--100.Google ScholarCross Ref
- Paré, G., Jaana, M., & Sicotte, C. (2010). Exploring health information technology innovativeness and its antecedents in Canadian hospitals. Methods of Information in Medicine, 49(1), 28--36.Google ScholarCross Ref
- Paré, G., Raymond, L., Ortiz de Guinea, A., Poba-Nzaou, P., Trudel, M. C., Marsan, J., & Micheneau, T. (2015). Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada. International Journal of Medical Informatics, 84(10), 857--867.Google ScholarCross Ref
- Paré, G., & Sicotte, C. (2001). Information technology sophistication in health care: An instrument validation process among Canadian hospitals. International Journal of Medical Informatics, 63(3), 205--223.Google ScholarCross Ref
- Plebani, M. (2009). Exploring the iceberg of errors in laboratory medicine. Clinica Chimica Acta, 404(1), 16--23.Google ScholarCross Ref
- Plebani, M., Laposata, M., & Lundberg, G. D. (2011). The brain-to-brain loop concept for laboratory testing 40 years after its introduction. American Journal of Clinical Pathology, 136(6), 829--833.Google ScholarCross Ref
- Poropat, A. E. (2009). Meta-analysis of the five-factor model of personality and academic performance. Psychology Bulletin, 135(2), 322--338.Google ScholarCross Ref
- Raymond, L., Paré, G., & Marchand, M. (2019). Extended use of electronic health records by primary care physicians: Does the EHR artefact matter? Health Informatics Journal, 25(1), 71--82.Google ScholarCross Ref
- Ross, S. E., Schilling, L. M., Fernald, D. H., Davidson, A. J., & West, D. R. (2010). Health information exchange in small-to-medium sized family medicine practices: Motivators, barriers, and potential facilitators of adoption. International Journal of Medical Informatics, 79(2), 123--129.Google ScholarCross Ref
- Saga, V., & Zmud, R. W. (1994). The nature and determinants of IT acceptance, routinization, and infusion. In L. Levine (Ed.), Diffusion, transfer, and implementation of information technology (pp. 67- 86). New York, NY, USA: North-Holland.Google Scholar
- Singh, H., Thomas, E. J., Sittig, D. F., Wilson, L., Espadas, D., et al. (2010). Notification of abnormal lab test results in an electronic medical record: Do any safety concerns remain? American Journal of Medicine, 123(3), 238--244.Google ScholarCross Ref
- Snow, J. (2012). Qualtrics survey software - handbook for research professionals. Provo, UT, USA: Qualtrics Labs, Inc.Google Scholar
- Stroobants, A. K., Goldschmidt, H. M. J., & Plebani, M. (2003). Error budget calculations in laboratory medicine: Linking the concepts of biological variation and allowable medical errors. Clinica Chimica Acta, 333(2), 169--176.Google ScholarCross Ref
- Sykes, T. A., Venkatesh, V., & Rai, A. (2011). Explaining physicians' use of EHR systems and performance in the shakedown phase. Journal of the American Medical Informatics Association, 18(2), 125--130.Google ScholarCross Ref
- Trudel, M. C., Marsan, J., Paré, G., Raymond, L., Ortiz-de-Guinea, A., Maillet, É., & Micheneau, T. (2017). Ceiling effect in EMR assimilation: A multiple case study in primary care family practices. BMC Medical Informatics and Decision Making, 17(1), 46.Google ScholarCross Ref
- Tu, K., Mitiku, T. F., Ivers, N. M., Guo, H., Hong, L., et al. (2014). Evaluation of electronic medical record administrative data linked database (EMRALD). American Journal of Managed Care, 20(1), e15--21.Google Scholar
- Urban, E., Ose, D., Joos, S., Szecsenyi, J., & Miksch, A. (2012). Technical support and delegation to practice staff - status quo and (possible) future perspectives for primary health care in Germany. BMC Medical Informatics and Decision Making, 12(1), 81.Google ScholarCross Ref
- Venkatesh, V., Morris, M. G., Davis, G. B., & Davis. F. (2003). User acceptance of information technology: Toward a unified view. MIS Quarterly, 27(3), 425--478.Google ScholarDigital Library
- Vest, J. R., & Jasperson, J. (2011). What should we measure? Conceptualizing usage in health information exchange. Journal of the American Medical Informatics Association, 17(2), 302--307.Google Scholar
- Wang, B. B. L., Wan, T. T. H., Bazzoli, G. J., & Blossom, Y. J. L. (2005). Factors influencing health information system adoption in American hospitals. Health Care Management Review, 30(1), 44--51.Google ScholarCross Ref
- Wernerfelt, B. A. (1984). A resource-based view of the firm. Strategic Management Journal, 5(2), 171--180.Google ScholarCross Ref
- West, D. R., James, K. A., Fernald, D. H., Zelie, C., Smith, M. L., & Raab, S. S. (2014). Laboratory medicine handoff gaps experienced by primary care practices: a report from the shared networks of collaborative ambulatory practices and partners (SNOCAP). Journal of the American Board of Family Medicine, 27(6), 796--803.Google ScholarCross Ref
- Whitacre, B. E. (2015). Rural EMR adoption rates overtake those in urban areas. Journal of the American Medical Informatics Association, 22(2), 399--408.Google ScholarCross Ref
Index Terms
- Enabling Laboratory Medicine in Primary Care Through IT Systems Use
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