The patient portal and Positive tests

Vic Nicholls nichollsvi2 at GMAIL.COM
Tue Mar 10 02:20:39 UTC 2015


I think where you are going to have the real problem is with
interpretation and relationships between various levels and drug
effects. If a "new" person sees high cholesterol they might have a
problem if they don't know to look at the HDL and LDL and see which one
of those is high. Or they had a bad skin reaction, got put on steroids,
and their cholesterol goes up. No sweat to a doctor, but the patient
might have an issue.

I know when I help people on bloodwork, I'll ask did you get X tested or
what was Y lab, and it won't be done. Or they just look at the basic
stuff and don't know where to go from there. Calcium/kidney
interrelationships are the first things to come to mind that I see, any
type of thyroid testing is also.

Victoria


On 3/9/2015 7:52 PM, Swerlick, Robert A wrote:
> They are probably as well tested as the protocols and tools they
> replace. That said, you are absolutely correct in that what we are
> witnessing a huge change.
>
> Robert A. Swerlick, MD
> Alicia Leizman Stonecipher Chair of Dermatology
> Professor and Chairman, Department of Dermatology
> Emory University School of Medicine
> 404-727-3669
> ------------------------------------------------------------------------
> *From:* Robert Bell
> [0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
> *Sent:* Monday, March 09, 2015 12:09 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] The patient portal and Positive tests
>
> Interesting.
>
> An advancement, but patients are like physicians, not all are good
> "proof readers" - but a true improvement I think. Will more easily
> interpreted/understood words for patients eventually be used? To me it
> is a big, big change with immense consequences.
>
> Does anyone know if portals were well tested prior to introduction?
>
> Rob B
>
> Sent from my iPad
>
> On Mar 9, 2015, at 6:18 AM, "Bruno, Michael" <mbruno at HMC.PSU.EDU
> <mailto:mbruno at HMC.PSU.EDU>> wrote:
>
>> Hi Bob,
>>
>> One thing the patient web portals seem to be changing is the quality
>> and clarity of Radiologists’ written reports.  Because of the
>> portals, the Radiologist’s report is now under more “quality
>> pressure” than ever, since their readership has been suddenly
>> expanded to include a brand new audience—the patients themselves.
>> Turns out patients are typically much more critical of flaws in the
>> reports than the referring physicians are/were, and so they are
>> providing very powerful feedback to the report writers.  So that’s at
>> least ONE positive development from the portals. See the attached PDF
>> of an essay I co-authored last year on that topic, which was
>> published in the Journal of the ACR.
>>
>> Theoretically, if there is enough patient engagement around the
>> portals, errors and misunderstandings might be caught and cleared up
>> before harm is done by having the patient serve as the final
>> ‘proofreader’ of their own medical record.
>>
>> All the best,
>>
>> Mike B.
>>
>> Hershey, PA
>>
>> *From:*robert bell
>> [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
>> <mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
>> *Sent:* Sunday, March 08, 2015 3:28 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> *Subject:* Re: [IMPROVEDX] Positive tests
>>
>> Great Post Peggy,
>>
>> Do you think the Portal internet revolution will change anything for
>> the better or worse? Also, Dr. Pronovost first did a study at Johns
>> Hopkins with his catheter infection study before it was expanded to
>> save so many lives. Do we know if studies were done with the new
>> Portal initiative prior to going public/nationwide to work out any
>> kinks?
>>
>> Brings up the issue of what level of study needs to be done to
>> recommend *anything* to prevent errors in diagnosis (or for that
>> matter all errors in medicine). Can you recommend to all something
>> which just seems common sense without studies?
>>
>> Rob B
>>
>> Brings up the issue that I have mentioned before regarding
>> standardizing procedures and building in double checks etc.
>> Theoretically, that could be done tomorrow.
>>
>>     On Mar 8, 2015, at 10:52 AM, Peggy Zuckerman
>>     <peggyzuckerman at GMAIL.COM <mailto:peggyzuckerman at GMAIL.COM>> wrote:
>>
>>     There are studies which show that up to 15% of labs which
>>     indicate abnormal findings are not conveyed to the patient.  One
>>     hopes that this info is not always critical.
>>
>>     On a larger scale, when the patient never receives a copy of the
>>     labs, there is no reason for that patient to feel at all
>>     responsible for the numbers!  In effect, this teaches the patient
>>     that he is not responsible for his own healthcare, with often
>>     disastrous consequences.
>>
>>     Of course, a patient who can compare lab results over a period of
>>     time may note trends that are missed by the doctor's review, or
>>     note something else that was not initially of concern during the
>>     previous appointment.  Could be cholesterol, WBC, or platelets,
>>     when the appointment was about blood pressure issues.
>>
>>     Not only should blood labs be given to patients, so should
>>     radiology reports.  Cannot tell you how many times patients in my
>>     kidney cancer group indicate that there was a tumor noted on a
>>     report, but never mentioned by the doctor. Perhaps a too-cursory
>>     look by the doctor, but such a finding would be noted by the
>>     patient, questioned and lead to an earlier diagnosis.
>>
>>     Peggy Z
>>
>>     On Sun, Mar 8, 2015 at 8:46 AM, Robert Bell <rmsbell at esedona.net
>>     <mailto:rmsbell at esedona.net>> wrote:
>>
>>     Many doctor's offices only call or mention to patients positive
>>     test results that have been undertaken (particularly lab tests).
>>     Is that a good thing and does it in any way impact diagnosis?
>>
>>     Also, what are the effects of the new electronic portals on
>>     diagnosis. It is a big change in medicine.
>>
>>     Rob Bell
>>
>>     Sent from my iPad
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>>     --
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>>     Peggy Zuckerman
>>     www.peggyRCC.com <http://www.peggyRCC.com>
>>
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