[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

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Mon Oct 15 22:57:49 UTC 2018


Dear Ed et al
Of course, it is easy enough to give up (for Lent, for a new diet, from
your budget) that which didn't really matter that much anyway!  It might be
interesting to ask the specialists who use varying approaches to treat the
same type of cancer what they wish the other parties would stop doing.  I
am a kidney cancer patient advocate, so naturally see lots of variations in
how urologists tell their patients NOT to see an oncologist, or the general
oncologist assuring the patient that he does not need to see a specialist,
or all of them telling the young kidney cancer patient that his disease is
just the same disease as the 60-year old with a similar-ish tumor.

Might also start the real revolution by helping patients understand
something about lab values, as in the primary discussion, so that we learn
that a hemoglobin that is 11.5 and 'low' is not that same as hemoglobin
that is 6.6 and 'low'.  A BMI of 27 is not the same as a BMI of 33, etc, etc
Peggy Zuckerman
www.peggyRCC.com


On Mon, Oct 15, 2018 at 2:27 PM Edward Hoffer <ehoffer at gmail.com> wrote:

> I would be careful who you ask to do this.  My biggest gripe with the
> "Choosing wisely" campaign is that the various specialty societies tended
> to pick items that did not affect the pocketbooks of their members.
> Thus the orthopedists recommended against things like post-op routine US
> for DVT but did not go near arthroscopies for minor meniscus tears in
> arthritic knees!
> Edward Hoffer MD
>
> On Mon, Oct 15, 2018 at 12:31 AM Peggy Zuckerman <peggyzuckerman at gmail.com>
> wrote:
>
>> Just as the ABIM asked each of its specialty groups to  determine which
>> of their tests/advice was likely less valuable, etc , leading to the
>> "Choosing Wisely" campaign, is there a way to have a "Evaluating Wisely"
>> push in the lab and imaging fields?
>> Peggy Zuckerman
>> www.peggyRCC.com
>>
>>
>> On Sun, Oct 14, 2018 at 7:59 PM Beth A. Martin MD <martinb at stanford.edu>
>> wrote:
>>
>>> Two very helpful data management tools which interface with VA CPRS ,
>>> not as complex as you are proposing but are worth seeing as they at least
>>> extract appropriate data and support pattern reading :
>>>
>>> Anticoagulation pharmacist dashboard for warfarin anticoagulation
>>> monitoring
>>>
>>> The interface of BCMA barcoding and laboratory test interface with the
>>> graphing function under laboratory tests tab
>>>
>>> And, in my opinion what epic should provide to every client for case
>>> finding and association : a HITT tool. Alerts and hard stops for decline in
>>> platelet count by 30 and 50 per cent on any patient who has received
>>> heparin in past or currently receiving heparin
>>>
>>> Beth Martin
>>> Stanford adult Hem
>>>
>>> Sent from my iPhone
>>>
>>> On Oct 14, 2018, at 1:56 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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>>
>>
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>>
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>> Medicine
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>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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