[Marketing] [IMPROVEDX] Doctors are surprisingly bad at reading lab results. It=?UTF-8?Q?=E2=80=99s_?=putting us all at risk. - The Washington Post

Tom Benzoni benzonit at GMAIL.COM
Sun Oct 14 22:10:54 UTC 2018


Just thought:
As I've started to teach this, I've been intrigued by Fagan nomograms.
Anyone familiar with a method whereby we could customize these to the task
at hand?
tom

On Sun, Oct 14, 2018 at 3:56 PM Swerlick, Robert A <rswerli at emory.edu>
wrote:

> There is a major barrier to deploying these tools, even if they exist,
> that being the lack of clear $ ROI. When such initiatives are put forth,
> creating a safer and more functional care environment ALWAYS takes a back
> seat to any project that has a positive financial ROI.
>
>
> 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:* Jackson, Brian <brian.jackson at ARUPLAB.COM>
> *Sent:* Sunday, October 14, 2018 10:32 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] [Marketing] [IMPROVEDX] Doctors are
> surprisingly bad at reading lab results. It’s putting us all at risk. - The
> Washington Post
>
> I think that time-based visualization (my translation of your term “event
> tracking”) might be the biggest single opportunity here.  For example, we
> can in theory create paragraphs of explanatory text around a single lab
> result, but it will never be nearly as useful as visually displaying that
> result in the time-based context of other tests and clinical events.
>
> One of the interesting challenges is that there are many different time
> scales of interest, and that can be relevant to interpreting a specific
> event.  Some issues evolve over minutes to hours, others over the course of
> a hospitalization or flare up episode, others over years.
>
> —Brian
>
> Sent from my iPhone
>
> On Oct 12, 2018, at 7:15 PM, Sidney Smith, M.D. <ssmithmd at COMPLETE.MD>
> wrote:
>
> Brian and Helene highlight the underlying assumption and deficiency of the
> Electronic Medical Record.
>
> EMR software language HL7 shares PDF files or images of data linked to a
> patient for storage. Integration or interoperability, today, means lines of
> data in a file match up. This is a way to share a PDF or word file but this
> will *never* achieve the goal of communication that everyone envisions.
>
> The EHR was build to work like paper and not as a communication platform.
>
> To achieve EHR functional interoperability we have to track the event
> associated with the patient and not the patient with the event.
>
> Every communication company tracks events - FedEx, UPS, Amazon, Google,
> Delta, Suntrust, Bank of America,  etc except medicine.
>
> Once your conceptually move to event tracking,  you can link data across
> the care continuum creating what you both envision.
>
> Sidney Smith MD
>
>
>
>
>
>
>
> Sent from my Verizon, Samsung Galaxy smartphone
>
>
> -------- Original message --------
> From: HM Epstein <hmepstein at GMAIL.COM>
> Date: 10/12/18 7:11 PM (GMT-05:00)
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] [Marketing] [IMPROVEDX] Doctors are surprisingly
> bad at reading lab results. It’s putting us all at risk. - The Washington
> Post
>
> That’s really fascinating and helpful. So, Brian, why can’t the
> information we’re discussing be included in the ASCII text? For example,
> I’ve seen text information under a test result range from three words to
> five full lines.
>
> When you get a cardiovascular work up or an MRI or a CAT scan you get a
> report that’s a couple of pages long. Why can’t those include information
> that would be helpful to determining next steps?
>
> For patients to be able to truly participate in their own healthcare team,
> they need to have information at their fingertips. For overworked
> clinicians to ensure that their communication to the patient is clear and
> understandable, it’s helpful for them to have something documented they can
> share. Is there a chance that laboratories and radiologists and other
> testing facilities could document the type of data points that might lead
> to patients getting a real opportunity to understand their options?
>
> Perhaps I’m looking in the wrong direction by asking the testing
> facilities to provide this information but it seems to be a piece of
> inexpensive, low hanging fruit that might help reduce Dx error.
>
> Any other suggestions ImproveDx listserv folks?
>
> Best,
> Helene
>
> On Oct 12, 2018, at 6:09 PM, Jackson, Brian <brian.jackson at aruplab.com>
> wrote:
>
> As a clinical laboratory person, I read this with great interest.  I
> totally agree that we ought to be doing more to communicate the meaning of
> lab results, rather than just delivering the results.  But doing this
> requires that we have better communication tools at our disposal.  Modern
> healthcare IT infrastructure and interoperability standards have focused
> far more on computer interfaces than human interfaces.
>
>
>
> More specifically:  Clinical lab results are in most cases delivered from
> laboratory information systems via HL7 interfaces to EHR systems.  A lab
> result message essentially consists of a few fields including the test
> name, result, units, reference range, high/low/critical flag as applicable,
> and then an optional freetext field that can include explanatory comments
> and regulatory boilerplate.  All of this is plain, unformatted ASCII
> freetext.  Laboratories have no control over the ultimate visual display of
> the information.  Fonts and font sizes are completely under the control of
> the EHR.  Even simple things like use of italics and bolding are not
> available.  Let alone the potentially really useful things like graphical
> presentation, hyperlinked information, etc.  As a result laboratories are
> incredibly limited in the type and quantity of information we can attach to
> a lab result.
>
>
>
> The medical informatics world has put an enormous amount of effort over
> recent decades into data exchange standards such as HL7.  Which are
> certainly important and valuable.  But unfortunately there hasn’t been
> nearly the same effort put into human-to-human communication.  I see some
> little changes coming out at the IT edges, but not a whole lot or very fast.
>
>
>
> --Brian Jackson
>
>
>
> *From:* HM Epstein [mailto:hmepstein at GMAIL.COM <hmepstein at GMAIL.COM>]
> *Sent:* Friday, October 12, 2018 3:16 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [Marketing] [IMPROVEDX] Doctors are surprisingly bad at
> reading lab results. It’s putting us all at risk. - The Washington Post
>
>
>
> An important article by epidemiologist Daniel Morgan in the Washington
> Post.
>
>
>
> Perhaps test results from laboratories should come with information on the
> specificity and reliability of the results. And specialists could provide
> standardized information on the probability of disease.&=
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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