Results and Reports Management
Prescribers (including physicians, medical trainees, nurse practitioners, clinical assistants and other healthcare professionals) order laboratory tests, diagnostic imaging, physiologic measures, functional tests and other diagnostic interventions in the course of health care. Results or reports related to these interventions are returned to the prescriber for consideration.
This section highlights how laboratory test results and diagnostic imaging reports (“Results” hereafter) are delivered (“routed”) to prescribers who use Connect Care as the record of care for any portion of their clinical practice.
The Connect Care clinical information system (CIS) includes laboratory information services. Until the CIS completes implementation throughout AHS, provincial laboratories, partner organizations, clinics and providers entering agreements to use Connect Care, some Results routing challenges will reflect the complexity of having diverse legacy and external systems sharing information.
Alberta patients see healthcare prescribers in one or more of two information system contexts that affect how interventions are ordered and Results are routed:
Where Connect Care is the record of care (“Internal”),
including all AHS facilities and all other entities adopting Connect Care.
Where Connect Care is not the record of care (“External”),
including a variety of Electronic Medical Records (EMRs) and some paper records.
Alberta prescribers may work entirely internally, entirely externally, or with a mix of both internal and external health services.
The general rule is that Results are routed to the context in which they were ordered. Results for interventions ordered in Connect Care are routed internally; Results for interventions ordered in external contexts always route to the system where the order was placed, in addition to being visible in Connect Care.
Results routing is further affected by whether the associated order was placed in an inpatient (including emergency department) or outpatient setting.
Intervention orders placed during an inpatient encounter can generate results that report during the admission or after the patient is discharged. The former are reviewed within the Connect Care chart and are not routed to an In Basket; the latter are routed to the In Basket of the attending (most responsible) prescriber at the time of discharge.
Results for outpatient interventions ordered within Connect Care always route to the In Basket of the ordering prescriber; there is no option for automated routing via fax or mail. Results for outpatient interventions ordered from outside Connect Care always route to the context where the order was placed; in addition, they are visible in Connect Care via chart review.
Ordering prescribers can copy (CC) another prescriber at the time of ordering to ensure that the copied provider also receives the Results. Connect Care prescribers always receive a copied result via In Basket. This can help locum prescribers, for example, who want to ensure that the prescriber they are covering for receives an independent copy of a key result.
Ordering prescribers can also copy (CC) themselves. This can be useful if the prescriber works in a "mixed context" (some clinical activity where Connect Care is the record of care and other activity where Connect Care is not the record of care). The copied result can be reflected, via "eDelivery", in the prescriber's external electronic medical record if that is set up as the default delivery location for that prescriber.
Protocols for calling critical results to responsible providers are unchanged before, after and during Connect Care transitions. The attending prescriber is usually called first. The ordering (authorizing) prescriber, or on-call delegate, may be contacted directly. All prescribers must arrange clear and current critical results reporting pathways and ensure that these are known to the facility where they work.
Selective In Basket Notifications
Whether or not a particular laboratory or imaging result is automatically In Basket-routed, prescribers can mark specific tests for explicit notification. This is useful when there are high-stakes results that the clinician needs to review as soon as available, before the chart might otherwise be checked. Additionally, this capability serves well if an imaging study is likely to be re-reviewed or reported after the clinician has considered preliminary findings.
Clinicians who are not routinely on Connect Care may wish to be notified by email when test results appear in the In Basket, as might happen if there are late-reporting results after an inpatient or emergency encounter has finished. One or more categories of In Basket message (e.g., test results) can be set to trigger email messages indicating availability of new content at user configurable intervals.
Prescribers with "mixed-context" practices need to be aware of a situations where Results might route to both their Connect Care and external EMR systems.