What are eResults?
eResults are electronic results that make their way into EMR (Electronic Medical Record) as tasks. They typically consist of labs, imaging and other clinical documents.
How do eResults get sent to my EMR?
Results generated from the provincial HIS (Meditech) get sent to NLCHI and distributed simultaneously to HealtheNL and the Telus integration service for EMR. On the way to EMR distribution, the results get filtered through the eResults Relationship Service so that only relevant items are distributed to EMR. This requires the Provider to have an eResults subscription for the EMR instance where they work.
What results get sent to EMR?
This depends partly on the nature of the practice and partly on provider preference. There are many different types of results that can be delivered, determined by the provider relationship to the results and the setting from which the result is generated. This is consistent with the method used by Meditech to enable the printing of results for providers. There are also two types of eResults subscription, there is the Primary results subscription and the Secondary results subscription.
Primary Results Subscription: A Provincial working group consisting of representation from the DHCS, RHAs and the Physician community, with advice from the CPSNL and CMPA decided on the minimum results delivery standard you see below. Without getting lost in the details of the diagram, what this illustrates is that the smallest subset of results that can be received consists of Preadmission and Outpatient results where the provider is the Ordering provider or CC’ed on the result as well as Outpatient and Emergency results where the provider is the Family provider. This subscription would typically be in place for the site where a Provider who primarily works in an EMR is carrying out most of their clinical activities.
Secondary Results Subscription: As program understanding of the many eResults scenarios has evolved and we have seen Providers working in multiple EMR instances, it has become necessary to implement a supplementary standard for those secondary locations. As can be seen below this results in only what is ordered by the Provider at the secondary site being delivered to the EMR instance.
Wait a minute, that is not always what happens!
In reality there are some significant factors that influence this idealized distribution of eResults. eResults are distributed first on the basis of the EMR Clinic ID that is on the requisition. The secondary distribution factor is the physician ID on the requisition. All requisitions generated from the EMR should have an EMR ID on them. However, the population of these pieces of information on the result registration relies entirely on the human on the registration desk. Therefore we often find that some pieces of information get omitted, modified or added during the registration process. All of these changes can result in a departure from the idealized distribution of eResults described above. The impact that this has is that, while eResults works as it is conceived and setup, not every result gets distributed as planned due to factors that are largely beyond eDOCSNL influence. In particular, if the EMR Clinic ID is left off the registration, the result will flow to every EMR where the provider works.
What has happened to paper results?
Paper results are turned off for nearly every type of lab result for providers who have a Primary eResults subscription. This would include providers who primarily work in clinics using EMR with eDOCSNL. This is important because before paper was turned off there was a back-up system for results delivery. This means that if there was a problem with delivery of an electronic lab result, the paper would have served as a failsafe. Paper delivery for Medical Imaging and other clinical documents has not been turned off yet, eDOCSNL is working towards that goal.
What is the risk to providers and patients now that paper lab delivery is turned off?
If results do not get distributed as intended there may be no notification of delivery of a result to a most responsible provider. These results would still be available in HEALTHeNL but no task would be generated in EMR. This may provide a gap in care which has potential patient safety and medicolegal implications.
What does eDOCSNL do to protect providers and patients?
During the pre-implementation planning for all providers, the program gathers information on physician and EMR IDs to populate the relationship service accurately to facilitate results distribution. There is an audit mechanism in place to ensure this is done correctly. When providers begin to receive results, program staff carry out a validation exercise to ensure everything is working as intended. We also ensure that the results that get generated in Meditech make their way to EMR drop-boxes by a mutual audit process with Telus. When eDOCSNL receives reports of results not distributed as intended, we investigate to find where the error has occurred. In the vast majority of these, the error has occurred at the registration step. We are always working with the RHAs to highlight issues with results delivery and improve process as well as exploring technical solutions, where possible.
If a result is received in error or a provider notices that you a result was not received that should have been, we ask end users to report this. We cannot identify issues without end user support. Submit a Ticket with Telus through the support desk and refer to this workflow for addressing misdelivered results.
Core messages on eResults:
- Results are sent from Meditech and filtered through the eResults Relationship Service.
- The technical process of distributing eResults works as intended but human factors sometimes influence how these results get distributed in reality.
- Results that do not get delivered as intended can have patient safety implications.
- Providers who work in multiple EMR instances may see some duplication of test results due to registration variations.
- Locums who work for a physician in an EMR will continue to receive paper, due to registration issues locums cannot simply assume that the provider being replaced in the EMR receives the result electronically. We do not enable eResults for locums as a general rule.
- Paper results distribution is to the Provider’s Meditech mailing address, please ensure this is up to date with the appropriate RHA.
- Paper results distribution has been turned off for most lab results but some are still sent on paper ONLY. Providers must still review their paper labs.
- It is ultimately the provider’s responsibility to manage their results and ensure they get to the right place.