Lab test to patients

Itzhak Brook dribrook at YAHOO.COM
Tue May 7 17:50:31 UTC 2013


The Washington Post Health Section published a
story today about medical errors which included also my own personal
experiences as a patient with throat cancer. I hope that this publication will
contribute to reducing future medical mistakes.
 
Itzhak Brook MD
 
 
http://www.washingtonpost.com/national/health-science/misdiagnosis-is-more-common-than-drug-errors-or-wrong-site-surgery/2013/05/03/5d71a374-9af4-11e2-a941-a19bce7af755_story.html
 
Itzhak Brook MD MSc
4431 Albemarle St. NW
Washington DC 20016 USA

 
Phone 202-744 8211
 
E-mail: dribrook at yahoo.com or ib6 at georgetown.edu
 
Blog site: http://dribrook.blogspot.com/



________________________________
 From: "jnavindr at AOL.COM" <jnavindr at AOL.COM>
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
Sent: Saturday, May 4, 2013 7:12 PM
Subject: Re: Lab test to patients
 


Yep and it applies to everything including the MD,s notes
 
jn
-----Original Message-----
From: Barnard, Cindy <CBarnard at NMH.ORG>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Sat, May 4, 2013 12:55 pm
Subject: Re: Lab test to patients


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. 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. 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. 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. 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 
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