Real-time Notification of Laboratory Data Requested by Users through Alphanumeric Pagers

The authors developed a novel feature in their clinical information systems, which allows clinicians to request notification about laboratory results. Clinicians who are expecting a particular laboratory result for a particular patient can request a report of the result via an alphanumeric pager as soon as the result is filed into the patient database. This feature has gained popularity and is heavily used in both inpatient and outpatient settings, at a rate of about 2,300 times per month. This event-monitor-based feature illustrates one way that information technology can be applied to improve communication in health care.Clinicians rely heavily on laboratory data to make medical decisions in various settings. However, the lag between the time when laboratory data become available and when clinicians review and act on them is considerable.¹ While certain clinical situations permit such delays, many do not. For example, a patient who has had gastrointestinal bleeding should have further units of blood cross-matched if it is clear the hematocrit has not responded to previous blood transfusions. The conscientious clinician who keeps checking the hospital laboratory information system for pending results can waste a lot of time doing so, and yet not checking may lead to unacceptable delays in patient care.Several groups, including ours, have developed applications that notify physicians when certain conditions apply.^1–10 For example, our group has developed an application that alerts physicians when life-threatening results are present, and that application has been shown to decrease the time it takes for a physician to act on such results.¹Previously described applications, however, were all designed to identify results that somehow are unusual or indicate gross deviation in a patient''s status from expected norms. In clinical practice, however, many results, including normal ones, may be important for decision making¹¹ and may warrant rapid notification of physicians. Furthermore, given the variety of user preferences¹² and the uniqueness of each clinical scenario, it may be difficult, at least with laboratory results in non-life-threatening cases, for an information system to predict whether a particular result merits urgent notification of a particular user.We designed an application—called “Result Notification via Alphanumeric Pagers,” or ReNAP—that allows clinicians to make this choice. Using this application, a clinician can indicate that he or she wants to be notified about a particular result for a particular patient, regardless of whether the result is abnormal. In this paper, we report the implementation methods, use statistics, and the results of a user satisfaction survey.