I read the article “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results”1 with interest and had similar expectations that electronic medical record (EMR)-enabled practices should have a lower incidence of missed laboratory results. Indeed, the practices with “partial-EMR” implementations had the highest failure rates. I suspect that these were practices that used an EMR system for progress notes, but received laboratory results via paper reports in the mail or fax. These paper reports must then be scanned into the system and somehow forwarded to the responsible clinician for review. This process introduces many opportunities for error, which could be avoided by eliminating the paper report; electronic laboratory interfaces should be established in all practices using an EMR. When properly implemented, a laboratory interface using the Health Level 7 (HL7) protocol will automatically route a patient's laboratory results to the ordering physician's “inbox” with clear flags for abnormal or critical results (similar to an email message marked “Urgent”). Of course, the practice should have a process in place to make sure results are not left unseen in a clinician's inbox while on vacation.
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