The main reason given for receiving results online was time savings, reported by 77% of participants, followed by lowering the chance of missing the results (31%).
Published Online: April 19, 2017
Azam Sabahi, BS; Leila Ahmadian, PhD; Moghadameh Mirzaee, PhD; and Reza Khajouei, PhD
Objectives: The laboratory, as a diagnostic department in the hospital, plays an important role in the treatment and prevention of diseases. Paying attention to patients’ preferences for communication of test results may provide a better and more responsive system for delivering these results. This study aimed to identify patient preferences regarding receiving their laboratory test results electronically and to identify the reasons behind their choice.
Study Design: Descriptive-analytical study.
Methods: This study was carried out in 2015 with 200 patients who had access to the internet and had been referred at least once previously to the hospital laboratory department to receive their test results. Data were collected through an expert-validated questionnaire, and its reliability was confirmed by test–retest (P = .8). Data were analyzed using χ2 and marginal independence SPSS and R software.
Results: Ninety-eight percent of participants preferred to be notified by short message service when their test results were ready. All participants preferred to receive their test results online, and 82.5% (n = 165) preferred to receive both normal and abnormal test results this way. The main reason for receiving results online was time savings, which was reported by 77% of participants, followed by lowering the chance of missing the results (31%). About 40% of participants thought e-mail notification was more secure than accessing the results through a hospital website.
Conclusions: Findings showed that although patients wanted to benefit from online services for receiving their test results, they were concerned about confidentiality and security. Before using online technologies, security measures necessary to protect patient privacy and to gain the trust of patients should be defined.
Several problems in the communication of laboratory test results, such as prolonged wait time, erroneous results reported, and missing results, result in patient dissatisfaction.
Online services were introduced as a way to improve the accuracy and timeliness of information communication; patients also show interest in using online technology to communicate with their healthcare providers.
We asked those patients with internet access about their preferences regarding the possibility of receiving their laboratory test results electronically. We found that they prefer receiving online results if the confidentiality and security of their information are ensured.
We recommend implementing the security measures necessary to protect patient privacy before deploying online patient–provider communication technologies.
The main goal of healthcare systems is to improve the public's health, which can be attained by the delivery of appropriate and required health services. Evaluation of a health system can be done through an assessment of its services.1,2 Obtaining patients’ opinions is a valid method for evaluating health services because patients are receiving healthcare and are a potential source of data; additionally, it is their right to have their opinions taken into consideration during processes of planning and evaluating.2 Patient satisfaction with a health institution’s services is among the most important tools for evaluation of system quality3; it can help staff and management to potentially revise their care methods.4
The laboratory, as a diagnostic department of a hospital, plays a significant role in the treatment and prevention of diseases. Heeding patients’ opinions about lab services is important for improving provider–patient communication and enhancing the department’s performance. Laboratory Information System, applied in this department, is a computer-based system that manages data on clinical chemistry, hematology, bacteriology, etc. The components of this system include hardware, software, data, and working processes that allow the professionals who are responsible for data collecting and processing and distributing test results to do so efficiently.5
Study results have shown that despite the existence of such systems in laboratories, patient dissatisfaction continues due to lack of system standardization and the systems’ poor performance.6,7 The most dissatisfaction relates to delays in receiving test results, missing results, or misfiling/misreporting the results.8-12 According to the findings of other studies, patients have great interest in using internet-based technology to communicate with their healthcare providers, to access their clinical records, and to obtain timely health information.13-18
Using internet-based technologies to receive test results contributes to decreasing the wait time, increasing patient satisfaction, reducing multiple visits to receive the results, and, to some degree, possibly decreasing urban traffic. Moreover, such a system can have advantages for hospitals, such as requiring less laboratory/administrative staff to deal with paperwork, freeing up waiting rooms for other purposes, and saving the costs of printing lab results. However, the lack of face-to-face interaction with laboratory staff, and of their personal encouragement, may result in the failure of patients with abnormal lab results to plan for their next treatment steps. Still, a previous study showed that more than 80% of patients prefer to receive lab results electronically, such as via the internet.18 In Iran, except in a few laboratories, online sending of test results is not widespread. Most patients still have to be present at laboratory departments to receive their test results.
To our knowledge, no study has addressed the preferences of Iranian patients regarding online delivery of laboratory test results. Our objective was to examine patient preferences, priorities, and recommendations for delivering laboratory test results electronically. This was a pre-implementation study conducted for the purpose of developing an online system for the delivery of test results. The findings can be of value for other organizations with similar goals as well.
Study Setting and Sample
This was a cross-sectional descriptive and analytic study carried out with the cooperation of patients visiting the laboratory department of a university hospital in Ferdows, Iran. A wide range of tests, including biochemistry, hematology, parasitology, bacteriology, serology, immunology, hormonology, pathology, and gasometry, is done in this department.
Patients were included in this study if they had 1) a previous history of receiving test results from this department, and 2) access to the internet. A sample of 195 patients was calculated using Cronbach’s alpha sampling method; ultimately, 200 patients were invited to participate.
Data and Measures
A researcher-made data-collecting questionnaire was designed based on the review of literature.19-22 The validity of the questionnaire was confirmed by 4 medical informatics experts who have a background in medicine and health information management.
Its reliability was examined using the test-retest method (P = .8).
The questionnaire consisted of 4 sections: 1) demographic data such as age, education, marital status, occupation, and residential address; 2) 2 questions about the time patients had spent to receive their test results in the previous encounter; 3) 12 questions about their use of information technology; and 4) 9 questions about the patients’ preferences and priorities for receiving test results, including their reasons, and their preferred method of test-results delivery (by e-mail; on the patient portal of a website, with or without short message reminder concerning presence of the results on the portal). One of the authors distributed the questionnaire to each patient visiting the lab who met the qualifications and then collected them after completion. The patients were instructed to complete the questionnaire, and their consent was inferred from their agreement to fill out the questionnaire.
Data analysis was done by SPSS software version 19 (IBM Corporation; Armonk, New York) and R software version 3.2.2 (R Foundation for Statistical Computing; Vienna, Austria) using descriptive and analytic statistics, including χ2 and marginal independence.
Data analysis showed that about half of the participants (n = 98; 49%) were 30 years or younger. Less participants had a bachelor’s degree (n = 78; 39%), most were married (n = 156; 78%), and almost half were employed (n = 88; 44%). The residential location of most participants (n = 131; 65.5%) was “city” (Table 1).
In their previous encounter getting laboratory test results, fewer than half of participants (n = 83; 41.5%) had spent less than half an hour; 35.5% (n = 71) spent between 30 and 60 minutes; 19% (n = 38), between 60 and 120 minutes; and 4% (n = 8), more than 2 hours to reach the hospital laboratory. In addition, 42% of participants (n = 84) said that once they arrived at the hospital, they had to spend 5 to 15 minutes waiting for their test results. The wait time for 32.5% (n = 65) of participants was about 15 to 30 minutes; for 12.5 % (n = 25), more than 30 minutes. The rest (13%; n = 26) had to wait for less than 5 minutes.
Participants’ Internet Use and Their Access to the Infrastructure
In this study, all participants had access to the internet. Almost half (n = 94; 47%) mentioned that they use the internet less than 30 minutes daily, while 8% (n = 16) of participants used the internet more than 3 hours a day (Figure).
Most participants (65.5%; n = 131) used the internet often to access social networks (Table 2). Most accessed the internet from home (n = 171; 85%), and 35% (n = 70) accessed it from work; 22.5% (n = 45) from public internet centers, 21.5% (n = 43) from friends’ homes, and 7% (n = 14) from their universities.
Of the participants, 74% (n = 148) had a personal e-mail address. The number of times they checked it included daily (n = 51; 34.5%), 1 to 2 times a week (n = 31; 20.9%), 3 to 4 times a week (n = 28; 18.9%), rarely (ie, less than once in a month) (n = 22; 14.9%), and 1 to 2 times a month (n = 16; 10.8%).
Forty-seven percent (n = 94) of the participants mentioned that they had already visited the hospital website. Among those, 84% (n = 79) reviewed the website to check the working schedule of the doctors, 13.8% (n = 13) to receive hygienic and health information, and 2.1% (n = 2) to do research.
All participants had cellphones and could receive and send text messages. They received 1 to 8 messages per day, but only about 10% (n = 21) of them received a maximum of 2 messages a day.
Participants’ Preferences for Notification of Test Results
Notifying the participants that their results are in via text on the same day the laboratory received the results was favored by 98% (n = 196) of participants, and all participants preferred to receive their laboratory test results online. When exploring the possible modes of laboratory result notification (by e-mail or on the patient portal), 52.5% (n = 105) of participants preferred notification by e-mail and 47.5% (n = 95) through the hospital website. About half of the participants (n = 101; 50.55%) believed that viewing laboratory test results online is completely useful. The rest, except 1%, felt this method of notification is partially useful.
Most participants (n = 154; 77%) gave “saving time” as the main reason for receiving laboratory test results electronically. Thirty-one percent (n = 62) said their main reason was preventing the paperwork from becoming lost by the participants (Table 3).