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Health See other Health Articles Title: Direct Access for patients to their Laboratory Results, a Good Idea? It is widely held that laboratory results represent 70-80% of actionable data in the medical record. With that information, it is indeed disturbing that a significant (up to 10%) portion of abnormal laboratory results are not communicated in a timely manner to patients. Perhaps in response to data like these, this past September several governmental agencies (CMS, CDC and the Office of Civil Rights) proposed a federal rule that would give patients upon request direct access to their test results. A new federal rule such as this would overrule existing law in 20 states. The rule is silent on waiting periods that are currently imposed by some medical practices on direct patient access to their test results in the EMR, but nearly all physicians agree that this is important to codify in any final rule. The proposed rule is still in a comment period and no date has been set for its implementation. This proposed rule was the subject of a recent commentary in the November 28th edition of JAMA by Giardina and Singh. They nicely describe what this proposed rule would mean from the patient and physician perspective and how it is important to balance the interests of both groups' concerns in any final rule. Direct to Consumer Genetic Testing was a subject of my blog a few weeks ago and 70% of readers stated that they supported this concept. This direct access to physician ordered tests would be an extension of this practice. Patients are increasingly expressing their desire to become more empowered in their own health care management, aided by the increasing number of excellent resources on the internet. Studies have shown that patients have an expressed interest in direct telephone contact with their physician concerning abnormal laboratory results; however, those cases that "fall through the cracks" in terms of not being communicated are a significant cause of patient injury and medical negligence claims. This is particularly true when there is more than one physician taking care of the patient and one of them assumes someone else will make the contact. Direct access of laboratory results for patients may be seen by the physician as undermining the physician's central role as the health information gatekeeper. Indeed it is well known that it is likely that a "normal" patient undergoing a 20 test metabolic panel will have at least one "abnormal" test result, with abnormality being defined by the laboratory as two standard deviations above or below the mean -- in other words, a 1/20 chance for any given test in an otherwise "normal" individual. The physician's office may be concerned that there will be a barrage of phone calls from patients concerned about minor abnormalities in test results that have no significant health consequences when taken in the entire context of the patient overall health status. On the other hand, a benefit for the physician may be a reduction in errors related to lack of transmittal of actionable abnormal test results. There is limited data in the literature at present regarding the risks and benefits of direct access of patients to laboratory tests. In some respects this represents unchartered water but the stage is clearly being set for a fundamental change in the way patients receive their test results. Giardina and Singh state in their commentary that "It is unlikely that patients will receive any coaching or personalized information on interpretation of results directly from the laboratory". This may not be a correct assumption given the College of American Pathologist's transformation of the specialty initiative, one fundamental aspect of which is to bring pathologists closer to direct interaction with patients. This could be a real growth industry for pathologists, filling a key niche patient's desire and decompressing an already overburdened primary care delivery system. Poster Comment: Bureaucrats doing something right for a change. Post Comment Private Reply Ignore Thread
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