This is a research study about implementing a clinic workflow to encourage pre-visit
laboratory testing, such as blood work. Resulting labs is a critical yet time consuming task
for primary care clinicians. Ideal and timely management of both normal and abnormal lab
results is best done when the patient and clinician are face to face in an office visit. This
allows patients to ask questions and clinicians to most efficiently make recommendations,
adjust or start medications, or order follow up testing. There is a notable and measurable
time commitment to the in-basket burden of sharing lab results via a patient portal or phone
calls, advising or counseling on these results and answering subsequent patient inquiries.
Furthermore, in a consumer-centric health system and one in which routine blood tests are
ordered for employment/insurance purposes and peace of mind, over-ordering of lab testing and
the subsequent associated anxiety of out of range results are both costly to the patient and
the health care system. Going "upstream" of the in-basket work associated with lab results
requires a workflow that maximizes staff time, emphasizes patient engagement and
understanding and most efficiently uses clinician time to guide good patient care.
The aims of this research study include to measure the feasibility of implementing a
pre-visit lab testing clinic workflow, which involves clinicians using the electronic medical
record (EMR) to indicate preferences that upcoming labs be completed prior to their scheduled
physical so that results can be discussed during the office visit, and to study the efficacy
of a pre-visit lab workflow as it relates to clinician in-basket time, staff time, patient
satisfaction, provider satisfaction, and frequency of patient encounters post visit.
The study has multiple components to test these aims. Approximately 4 sites will be engaged
to implement the study workflow for all prospective patients seen at the designated offices.
Site physicians and their clinic staff will be invited to attend a Lunch & Learn to discuss
the intent to implement pre-visit lab testing and confirm the details of the clinic workflow.
Data will be reviewed for progress reports and modifications to the clinical workflow can be
made at that time to adjust for implementation barriers.
Longitudinal data from a brief survey will be collected from clinical staff (e.g. providers,
practice managers, nurses, medical assistants, etc.) at three time points: prior to study
implementation, at 6-months of implementation, and at 1-year of implementation. Practices
will act as their own controls with their patients with labs resulted on/post-visit compared
to those resulted pre-visit. Data sources will include EDW data, Press-Ganey scores, and
physician surveys to assess time burden and satisfaction with workflow.
A secondary study component will involve anonymous patient surveys collected at every annual
physical or wellness visit for the duration of the study. Additionally, patient data will be
collected from existing sources (EPIC/Clarity, Press-Ganey, Enterprise Data Warehouse,
billing, etc.) to assess the effectiveness of the workflow as it relates to patient
understanding of their care.