[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

Lyn Behnke lynbehnke at GMAIL.COM
Mon Oct 15 15:52:46 UTC 2018


from  way back, I was taught that the function of testing, be it lab or radiology or electrical such as EEG, EMG, was primarily to confirm the diagnosis, and then monitor as appropriate.  The lab test taken out of context of the particular visit promotes misdiagnosis.  For example, one of my patients had a HGA1C of 8.2.  I was thrilled and called the patient and we celebrated.  But just looking at the number would indicate that his diabetes was out of control and a change was needed.  What we don’t see from this particular data point is that 3 months ago it was 13.5.  Consequently, the change in therapy that we made 3 months ago made a huge difference.  The issue the becomes, stay the course or intensify the treatment.  WE made the choice to stay the course for the next 3 months.  Then we will make the decision together as there are insurance, life style, family history, and other variables that go into interpreting that data point of 8.2.

 

From: Charlene Weir <charlene.weir at UTAH.EDU>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Charlene Weir <charlene.weir at UTAH.EDU>
Date: Monday, October 15, 2018 at 12:30 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

 

In my mind, lab results are tied to specific tasks, such as: 1) evaluating the effect of treatment, 2) making a diagnosis, 3) determining the severity of illness, or 4) assessing which treatment to use. People might infer those tasks from the surrounding context, but if they were linked to problems (#1 and #3), or new complaint, symptom (#2 or # 4), or both then it would be easier to grasp. Of course just the clinical timeline would provide a lot of information.

 

Charlene 

 

 

From: "Jackson, Brian" <brian.jackson at ARUPLAB.COM>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Jackson, Brian" <brian.jackson at ARUPLAB.COM>
Date: Sunday, October 14, 2018 at 10:15 AM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <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] 
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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