Lab test to patients

Amer, Kim KAMER at DEPAUL.EDU
Tue May 7 21:28:42 UTC 2013


I just wrote a textbook on the issue:  Quality and Safety for Transformational Nursing: Core Competencies.  published by Pearson.  It's just one little step to help keep us safer.  Kim

Kim Siarkowski Amer, PhD, RN
Associate Professor
School of Nursing
DePaul University
990 W. Fullerton suite 3003
Chicago, IL  60614
Office Phone 773-325-1160
Cell Phone 312-203-4355


________________________________
From: jnavindr at AOL.COM [jnavindr at AOL.COM]
Sent: Tuesday, May 07, 2013 2:44 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Lab test to patients

There are 98,000 deaths annually from medical errors--So far very little has been done. When the police went to one hospital to talk to them about their suspicions that a nurse was killing patients the hospital fired the nurse without any investigation. Turns out the nurse problably killed ~100 people and several institutions were suspicious but they all just let him go without reporting anything.

Imagine the uproar if the airlines had that kind of record  = 3 -747 crasshes per week with all passengers killed

jim n
-----Original Message-----
From: Itzhak Brook <dribrook at YAHOO.COM>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Tue, May 7, 2013 8:36 am
Subject: Re: Lab test to patients

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<mailto:dribrook at yahoo.com> or ib6 at georgetown.edu<mailto:ib6 at georgetown.edu>

Blog site: <http://dribrook.blogspot.com/> http://dribrook.blogspot.com/


________________________________
From: "jnavindr at AOL.COM<mailto:jnavindr at AOL.COM>" <jnavindr at AOL.COM<mailto:jnavindr at AOL.COM>>
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto:CBarnard at NMH.ORG>>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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<mailto: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<mailto: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<mailto: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<mailto: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/<UrlBlockedError.aspx>>



________________________________
From: Fantz, Corinne Renee [cfantz at EMORY.EDU<mailto:cfantz at EMORY.EDU>]
Sent: Saturday, May 04, 2013 11:28 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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><mailto: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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