Lab test to patients

robert bell rmsbell at ESEDONA.NET
Sat May 4 23:01:21 UTC 2013


Excellent.

So how do you get the ball moving to make in national policy?

Rob Bell
On May 4, 2013, at 11:04 AM, Barnard, Cindy wrote:

> Some recent and I think important citations are noted below, supporting the careful implementation of engaging the patient with test results - Not dumping the accountability on the patient, not assuming health literacy the patient may not possess, but opening up the possibility of a partnership where the patient is able, willing and desirous of that kind of relationship.
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> J Am Coll Radiol.<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed/19878886> 2009 Nov;6(11):786-94.
> Insight from patients for radiologists: improving our reporting systems.
> Johnson AJ<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Johnson%20AJ%5BAuthor%5D&cauthor=true&cauthor_uid=19878886>, Easterling D<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Easterling%20D%5BAuthor%5D&cauthor=true&cauthor_uid=19878886>, Williams LS<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Williams%20LS%5BAuthor%5D&cauthor=true&cauthor_uid=19878886>, Glover S<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Glover%20S%5BAuthor%5D&cauthor=true&cauthor_uid=19878886>, Frankel RM<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Frankel%20RM%5BAuthor%5D&cauthor=true&cauthor_uid=19878886>.
> Source
> 
> Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA. anjohnso at wfubmc.edu
> 
> Abstract
> PURPOSE:
> 
> The aim of this study was to seek patients' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient-centered by giving patients greater access to their personal health information.
> 
> METHODS:
> 
> Focus group methodology was used to explore which aspects of radiology information are important to patients and to identify their preferred means of access to and format of this information. Subjects for the two groups were outpatients who had recently undergone MR imaging at a single academic medical center. Transcripts were analyzed using thematic content analysis.
> 
> RESULTS:
> 
> Most subjects were dissatisfied with current reporting systems, citing delays and a lack of detail as the most important problems. Subjects varied with regard to preferences for who should relay results to them, with some expressing a desire for increased direct input from radiologists because they have greater expertise in imaging interpretation. Most subjects wanted results in writing and in detail, with attached lay language explanations, though a few subjects preferred less detail. Subjects were decidedly in favor of having the option to access results immediately via an online system, proposing some potential problems and potentially multiple benefits of such a system.
> 
> CONCLUSIONS:
> 
> Whatever system revisions are attempted to increase the patient-centeredness of care as regards to radiology reporting, patients will need to be able to choose their preferred levels of access and will need to have the option of accessing full details.
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> Am Coll Radiol. 2010 Apr;7(4):281-9.
> 
> Patient access to radiology reports: what do physicians think?
> Johnson AJ<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Johnson%20AJ%5BAuthor%5D&cauthor=true&cauthor_uid=20362944>, Frankel RM<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Frankel%20RM%5BAuthor%5D&cauthor=true&cauthor_uid=20362944>, Williams LS<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Williams%20LS%5BAuthor%5D&cauthor=true&cauthor_uid=20362944>, Glover S<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Glover%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20362944>, Easterling D<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Easterling%20D%5BAuthor%5D&cauthor=true&cauthor_uid=20362944>.
> Source
> 
> Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. anjohnso at wfubmc.edu
> 
> Abstract
> PURPOSE:
> 
> The aim of this study was to seek physicians' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient centered by giving patients greater access to their personal health information.
> 
> METHODS:
> 
> Focus-group methodology was used to explore physicians' views on direct patient access to radiologic test results. Subjects for the two groups were physicians at a single academic medical center. Transcripts were analyzed using thematic content analysis.
> 
> RESULTS:
> 
> Most participants were dissatisfied with current reporting systems. Both radiologists and referring physicians (RPs) were aware that patients are not satisfied with the current system for notification of radiologic test results, and both thought that patients should have access to personal health information and take responsibility for their own health care. Regarding direct patient online access to results, both radiologists and RPs were concerned that patients would not understand report contents and that such access would lead to greater patient anxiety and demands on RPs' time. Referring physicians were also concerned that direct patient access to results would cause RPs to lose some control in the patient-physician relationship. Both radiologists and RPs preferred that any system for direct patient access incorporate a time delay and be tested for effect before being implemented.
> 
> CONCLUSIONS:
> 
> Revisions attempting to increase the patient-centeredness of care in the area of radiology reporting should be developed and tested to 1) minimize adverse effects on patient anxiety; 2) optimize timing, considering effects on both patients and RPs; and 3) simultaneously address problems with between-physician reporting methods.
> 
> Copyright (c) 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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> J Am Coll Radiol.<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed/22469376> 2012 Apr;9(4):256-63.
> Access to radiologic reports via a patient portal: clinical simulations to investigate patient preferences.
> Johnson AJ<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Johnson%20AJ%5BAuthor%5D&cauthor=true&cauthor_uid=22469376>, Easterling D<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Easterling%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22469376>, Nelson R<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Nelson%20R%5BAuthor%5D&cauthor=true&cauthor_uid=22469376>, Chen MY<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Chen%20MY%5BAuthor%5D&cauthor=true&cauthor_uid=22469376>, Frankel RM<http://www.ncbi.nlm.nih.gov.ezproxy.galter.northwestern.edu/pubmed?term=Frankel%20RM%5BAuthor%5D&cauthor=true&cauthor_uid=22469376>.
> Source
> 
> Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA. anjohnso at wfubmc.edu
> 
> Abstract
> PURPOSE:
> 
> The aim of this study was to determine (1) the patient-preferred timing characteristics of a system for online patient access to radiologic reports and (2) patient resource needs and preferences after exposure to reports.
> 
> METHODS:
> 
> Adult outpatients from a single imaging center completed researcher-administered electronic questionnaires. Participants were exposed to 3 simulated clinical scenarios and asked to answer questions on the basis of what they thought they would do in each. Scenarios included symptomatology and written radiology reports that were nearly normal, seriously abnormal, and indeterminate, with reports containing typical medical terminology. Participants were asked about preferred timing for online access to reports, communication methods, educational resources, and alternative formats. McNemar's test correlated proportions and generalized estimating equations were used to evaluate responses.
> 
> RESULTS:
> 
> Participants (n = 53) most often preferred immediate access to reports: 32 (60.2%) for the nearly normal scenario, 25 (47.2%) for the seriously abnormal scenario, and 24 (45.3%) for the indeterminate scenario. Three-day delayed access was next most commonly preferred: 15 (28.3%), 19 (35.8%), and 19 (35.8%), respectively. Forty-two participants (79.2%) preferred the portal method of notification over ways they have historically gotten results, with an increased proportion being satisfied with it overall (P < .04). Most would use a variety of educational resources and found alternative lay language conclusions and hyperlinks helpful.
> 
> CONCLUSIONS:
> 
> Some outpatients want immediate online access to complete, written radiologic reports and would use multiple resources to understand report contents. Effects of immediate access on provider workflow and on anxiety and autonomy among a diverse population of patients still need to be studied.
> 
> Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.
> 
> 
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> 
> Cynthia Barnard MBA MSJS CPHQ
> Director, Quality Strategies
> Northwestern Memorial Hospital
> 211 E Ontario #1550
> Chicago IL 60611
> voice 312.926.4822
> fax 312.926.9879
> cbarnard at nmh.org
> 
> If you want to learn more about Northwestern Memorial Hospital,
> please visit our website at http://www.nmh.org<http://www.nmh.org/>
> 
> 
> 
> ________________________________
> From: Fantz, Corinne Renee [cfantz at EMORY.EDU]
> Sent: Saturday, May 04, 2013 11:28 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: Lab test to patients
> 
> I too agree that lab tests should be provided to patients if they are built in ways to improve quality and coordination of care not as they currently are (to collect incentive payments under significant time constraints).
> 
> There are unintended consequences that have not yet been considered by many IT vendors producing these reports from the "official" medical record.  Unofficial lab reports can be helpful but also can be misleading (eg. Not reflecting corrections, missing interpretations, poor formatting as there are no standards for patient reports as there are for "official" reports for clinical labs under CLIA).
> 
> Regards,
> Corinne Fantz,PhD
> Associate Professor
> Pathology and Laboratory Medicine
> Emory University School of Medicine
> 
> Sent from my iPhone
> 
> On May 4, 2013, at 11:34 AM, "Brian Goldman" <brian.goldman at CBC.CA<mailto:brian.goldman at CBC.CA>> wrote:
> I agree that lab tests should go to patients directly.  Any "needless" anxiety put upon the patient will be more than made up for by improved patient engagement as well as an opportunity to challenge the accuracy of the test results.
> 
> 
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