Sharing Data per Patient Preference – An analytical look at how patient preference -based data sharing might be operationalized. Thanks again, John. It is good to see posts about this part of the CMS rule that discuss how this can be done instead of how this cannot be done.
Posts Tagged ‘test-results’
Sharing Data per Patient Preference: Ideas on implementing the CMS Rule from John Halamka, MD
January 18th, 2010 | Popularity: 3% 0 comments | Leave a replyNow Reading: “Concern that sharing information with patients may cause sustained psychological distress is probably unfounded”
December 18th, 2009 | Popularity: 6% 9 comments
I’m not that smart and my ideas are not that unique.
This is why I enjoy writing the posts that are tagged “where we came from” on this blog.
The title of this one comes from a 1991 article published in the British Medical Journal about the idea of providing patients access to their complete medical record. To really dig deep, though, I wanted to grab the seminal 1973 article from The New England Journal of Medicine on this topic, and thanks to the Internet, I found it.
In Sounding board. Giving the patient his medical record: a proposal to improve the system (There appears to be a PDF of this article on the Internet here), authors Shenkin and Warner lay out some facts about the health system that don’t seem to different than those of today, sadly:
Dissatisfaction with the functioning of the medical care-system has become widespread. Four serious problems are maintaining high quality of care, establishing mutually satisfactory physician-patient relations, ensuring continuity and avoiding excessive bureaucracy.
Some differences were apparent in 1973, such as the fact that in 41 states, patients could only obtain their medical records through litigation (!). Also, it appears with the emergence of “centralized organization” though things like health maintenance organizations, that physician autonomy was under siege. The health system was considered at the time to be “decentralized to the penultimate step – the physician” and the fear was that their autonomy was “unchecked.”
All of that aside, the authors, quite visionary in my opinion, laid out an almost Web 2.0 version of the medical world.
They talked about the idea of “decentralized medical review.” A few quotes:
The freely available record would provide a more “longitudinal” view of a patient, and physicians would appreciate better (and treat better) the course of a disease. Since innovation proceeds mainly by the contagion effect, new knowledge would probably be put into practice more swiftly.
And this one
Decentralized peer review would provide recognition of excellence in the practice of medicine, and hence enhance the prestige of being a practicing physician. Patient records and the care that they reflected would become a source of pride open to the perusal of fellow professionals. The expected improvement in continuity would decrease frustrations, and improved physician-patient relations would add importantly to physician satisfaction.
Whoa. They are talking wisdom of crowds, viral innovation, and building trust through transparency. In 1973.
Flash forward to 1991. In The Right to Know, author McLaren discusses data from Denmark, which provided patients “statutory rights” to their entire hospital record, with no ill effects. He concludes:
The argument against giving patients greater access to their records has been lost; the challenge now is to get doctors skilled in writing records that their patients will find useful.
Whoa. He’s talking Meaningful Use.
1973 was before my medical time, but 1991 wasn’t. In 1991 I was in medical school, and I’m pretty sure if you asked me, “Ted, should your patients see what you wrote about them in that manila folder thing with paper?” I would have said, “Why shouldn’t they?”
Ironically, it’s probably the very group that opposed these viewpoints that are responsible for creating mine. Summer of 1991 was my first (and I think just one of 2) trips to the national meeting of the American Medical Association, in Chicago. That meeting was marked by protests from the HIV/AIDS community on the outside. And on the inside, after a week, I remember leaving with the thoughts, “I met a lot of great peers here, but who are these leaders who are resistant to technology and only allow heterosexual men to participate?* They aren’t me. And I’m not them.” This is the heritage of Generation X – we were groomed to be on the side of the patients.
So that’s my story, and the story of where we came from with regard to sharing medical records with patients. Has nothing happened in 18 years? Absolutely not.
- The largest medical groups in the United States regularly share medical records with patients, online
- Most patients have a “statutory right” to their hospital record, albeit, not in the most friendly or useful way (see this example from Tufts University)
- Crowdsourcing, trustbuilding, and transparency are sweeping the business world. Health care is on the verge.
- Generation X are the attending physicians and medical directors, Generation Y are graduating from their residencies.
In the Shenkin article, it was proposed that a law be passed to require that a “complete and unexpurgated copy of all medical records, both inpatient and outpatient, be issued routinely and automatically to patients as soon as the services provided are received.” They do a great job of covering every known objection, “firstly” through “ninthly.”
My favorite is of the fear of “poor quality review” by peers and patients. They said that in 1973, it is “safer for them (physicians) to measure adequacy by academic degrees achieved than by competence demonstrated.”
The great thing I have learned pretty solidly from so many people by 2009 is that the medical community has so much support from patients and families – they want them to be great, they will only help. One patient said this at a recent continuing education course to room of us: “Can I just say thank you for paying attention in medical school, you are in my thoughts, you have my full gratitude.”
Let’s please remember these words to keep the conversation about ending secrecy an easy one, not a hard one. And, carry these two articles in our back pockets at all times.
*The American Medical Association has since reversed its stance on discriminating against gay, lesbian, bisexual, and transgender physicians and patients.
When can patients have their data?
December 15th, 2009 | Popularity: 6% 12 commentsWhat a challenging conversation this can be.
Kudos and sincere thanks to the National Partnership for Women and Families and its hosted Consumer Partnership for eHealth for hosting the discussion entitled ““How Access to Information Can Empower Patients and their Caregivers” yesterday. It was the right place, right time, right group of people. I think we nearly split the atom.
e-Patient Dave in his post on e-patients.net did a nice job of summarizing the feeling on the part of the patients in the room, so I’ll just post what was going through my mind here.
After showing the images that I previously posted on this blog (you can see them here), a question was asked about sharing of lab results, imaging results, physician notes, and the like.
As you can see from Dave’s review of things, there appeared to be a difference of opinion about “when.”
The problem I see with the response of “yes, they should have their results; however…” or “yes they should see their data, but…” is that it reminds me of so many conversations I have had that go something like this:
“Ted, minorities (such as yourself) should have equal rights, no question about that. Just not now.”
That’s the reality I have lived, and I think for someone who is struggling to be respected in our health care system, this is how responses like the above can come across, as Dave’s blog post shows. This is why I turned to Dave and Regina and asked them to provide their personal experience, which they did, and very passionately so.
Instead of wondering,”Should the doctor see the results first?” let’s ask a deeper question: “When can patients have their data?” And…in more and more health systems, the answer is “whenever they want it,” with off-the-charts satisfaction on the part of patients and clinicians.
Yesterday really helped me understand that this is not going to be an easy conversation, however, I’m happy to participate in it, and invite the patient to be in the room while it is happening.
Why? Because I may have gone to medical school, but I have not yet had stage 4 metastatic renal carcinoma or cared for someone who has.
Why “Doctor Sees Results First” is harmful
December 14th, 2009 | Popularity: 5% 10 commentsHope Leman, who just did a wonderful job interviewing me on her blog, also asked me about this quote in a previous post:
“Not only do we now have information that this rule (”doctor sees results first”) is probably harmful, we are learning that it’s probably not wanted, from physicians, who are talking to patients.”
She asked me to clarify, which I am happy to do. Below is a graphical image of what two very important studies just showed:
Hope’s question:
I don’t see how that would be harmful. Do you mean because he would then be overly persuasive and the patient would be a weaker position info possession wise?
To clarify, I did not mean that it’s harmful for doctors to see test results before their patients. Not at all. I think if a physician seeing a result and then informing the patient in a timely manner is ideal. I also think the patient seeing the result and then having a dialogue with the patient is ideal, too, relative to what is not ideal.
What is not ideal is a significantly abnormal result coming back and the patient not finding out about it, for obvious reasons.
So what I meant was, “a workflow that doesn’t allow a patient to see their test results in a timely manner is harmful.” When a system requires the doctor to see the result before the patient can, there’s a risk that the patient will never get it. When there is failure to notify, there could be failure to treat, which can be devastating.
Beyond this risk, patients and families are not demanding that their doctors see their test results first anyway, so this is just another reason to change the rule “patient doesn’t get to see their test results until the doctor does.”
The key is patient (and family) access to their own results, so they can assist in the accuracy and safety of their care. And they will do it, as I quoted previously, from the Disruptive Women in Health Care blog:
Although we may not think it’s our responsibility to read our operative report or a pathology report… it could mean the difference between a good or bad result in the best case scenario, or life and death in the worst case scenario. In the end, your health information is just that…..yours. No one will care more about it, or own it, in quite the same way as you.
I hope this explanation was better; if not, comment away!
Now Reading: Patients want their radiology test results
November 5th, 2009 | Popularity: 4% 6 comments
Johnson AJ, Easterling D, Williams LS, Glover S, Frankel RM. Insight From Patients for Radiologists: Improving Our Reporting Systems [Internet]. Journal of the American College of Radiology 2009;6(11):786-794.[cited 2009 Nov 5 ] Available from: http://www.jacr.org/article/S1546-1440(09)00360-3/abstract
Actually, the title of this paper is “Insight From Patients for Radiologists: Improving Our Reporting Systems”
I’ve been heard to say that I don’t know where the rule that “the physician must see the test result before the patient” came from. (Once, someone in an audience responded, “From doctors!”) At the same time, there hasn’t been a lot of data that this de-facto rule isn’t what patients want.
That’s changing.
Not only do we now have information that this rule (“doctor sees results first”) is probably harmful, we are learning that it’s probably not wanted, from physicians, who are talking to patients.
This study is useful both because it addresses the latter issue, and because it is published in the radiology literature.
This study is a review of patient focus groups, with patients invited to discuss their experiences after having either normal MRI scans, or abnormal MRI scans. The results showed that patients had different opinions about who on their care team should discuss their imaging test results with them. However, when it came to getting a copy of those results, the patients were much less divided:
Participants were decidedly in favor of having the option to access test results immediately via an online system. Responding to open-ended questions about this option, they offered the following potential benefits: 1) such a system would allow them to better prepare for their next physician visits, especially to make the most efficient use of limited time with their physicians; 2) such a system would facilitate their ed- ucating themselves about their diseases or conditions; 3) it would empower them and give them more of a “partner”-type relationship with their regular doctors for decision making; 4) it would likely decrease the delay in taking the next steps in their care; and 5) it would facilitate their success in seeking social support.
I think people who have been working and practicing in health systems that offer patients access to their health information have known this for a long time – patients given the choice to access their information in real time achieve much greater benefit than those who are subject to delays, arbitrary or not. This published experience helps to confirm it.
As I have written about previously, the issue of sharing written imaging results has been controversial in the medical community. Imaging reports can be difficult to decipher by patients (sometimes, by doctors, too). They can also have a broad array of information and recommendations that need to be applied to the medical experience of a specific patient.
As a result, only a few organizations routinely share written imaging results with their patients. Does your health care provider/organization share your imaging test results with you? How, and in enough detail? If you’re a health care provider, what do you think of this information?
Now Reading: Follow-up of Abnormal Imaging (where’s the patient in the solution?)
October 8th, 2009 | Popularity: 3% 1 comment
On the heels of a recent study demonstrating problems with patients receiving notification of abnormal lab test results, this study offers more insight in the area of diagnostic imaging results. And…the problems are just as concerning. Tip of the blog post, by the way, to Anita Samarth, who tweeted these findings initially to me.
When talking about “imaging results,” we’re referring to things like chest x-rays, CT scans, and MRI scans. These are often ordered to check for the possibility of cancer.
In fact, 11 times, results that were not relayed to patients after 4 weeks were of an abnormality that turned out to be cancer.
The interesting difference between this study and the study referenced previously is that it was done in a setting with a robust electronic health record (EHR) – The Department of Veterans Affairs.
What was studied was whether the (well) functioning EHR resulted in patients learning of abnormal imaging studies, not whether there was a working process to have these results brought to the attention of doctor in the first place.
The results are similar to those seen previously – Of 123,638 outpatient studies, 1,196 results were flagged “critical. 92 of these 1,196 critical notifications, or 7.7 %, did not result in timely notification, defined as 4 weeks. I’d say many patients and their families would not even classify “timely” as 4 weeks.
So the news is not very good with our ability to involve patients and families in their imaging results, either.
One other tidbit that caught my eye related to all of this is that if two doctors were involved in the notification instead of one, there was a greater likelihood of an alert not being acknowledged. That difference disappeared, though, when it came to looking for follow-up in the chart.
The issue of accountability leads me to what impressed me about this paper, and sort of not in a good way. There is no discussion of the potential for patients to assist in timely notification by having access to their imaging results online. This is especially surprising considering that the Department of Veterans Affairs manages a very good patient online access portal, MyHealthEVet.
Was this an oversight (not considering patient access as a solution), was this approach considered but not discussed in the article, or was this approach not considered a good solution at all?
As mentioned in a post on the Disruptive Women in Healthcare blog, it is the patient who will “care more about it or own it” the most when it comes to medical information. This is especially true, I think, when multiple clinicians are involved.
I have discussed the value of providing imaging test results to patients here previously – Several organizations already do this, including Beth Israel Deaconness Medical Center, and Palo Alto Medical Foundation.
Why not have this a standard (patient access), if we now know that in even the most technologically advanced systems, failure of notification can happen, and can potentially be devastating?
How would you counsel this patient?
September 29th, 2009 | Popularity: 5% 0 comments | Leave a reply
This 2:45 clip from this week’s “Brothers and Sisters” dramatizes one of the most difficult experiences patients and physicians face in health care (make sure you watch the whole clip).
I was struck by the way the physician pre-counseled Calista Flockhart’s character:
- Should she have provided information differently?
- What should she have said if the result from the test wasn’t going to come back the same day?
With this vignette and another on 30Rock that I posted about previously, I imagine that the shows are trying to show a real view of health care, and also, for those who have experienced these situations, the hope that maybe the way things are today could be different.
This may be especially true now that we know that 7.1 % of abnormal tests in general and a percentage of abnormal imaging results may go unreported to patients.
It will be interesting to watch as this story unfolds if the character and her family are as involved in the care as they want to be. Will the pathology result be available to the patient and her family online?
Sharing Test Results With Patients – Vanderbilt
August 24th, 2009 | Popularity: 3% 3 commentsThank you to Jonathan Wald, MD, to pointing me in the direction of this video. It is about Vanderbilt School of Medicine’s patient portal, which in and of itself is impressive. However, the story about a patient finding an abnormality and changing the course of his care as a result is very impressive. See what you think. How would you like lab, radiology, and pathology test results delivered to you, and when?
Why provide patient access to imaging and pathology results? A True Story (Disruptive Women in Health Care blog)
August 20th, 2009 | Popularity: 6% 0 comments | Leave a replyAs I posted recently, a study has shown that 7.1 % of the time, there’s a failure to inform patients about abnormal test results. In half of practices studied, the policy was, “If you don’t hear from us, your results are normal.”
This story just published in the Disruptive Women in Health Care blog shows what this approach can mean to a patient and their family:
In this particular case, it was a pathology result that was not communicated to the patient.
Even though several leading edge health systems now routinely share lab test results with patients online, the regular sharing of radiology (imaging) and pathology test results, especially in an automated fashion, is still uncharted territory. In some states (Caliornia), sharing of some of these types of results with patients online is prohibited by law.
Why are pathology results (ranging from pap smears to biopsies) and imaging results treated differently?
The concerns range from fear of exposing patients to bad news as many of these tests are ordered with a high suspicion of abnormalities, to the lack of comprehensibility of these types of results, which are often not numeric, narrative, and very specific to a patients’ condition.
I put out two Twitter calls to ask about medical groups who have done this (automatically sharing imaging test results with patients), and I think this level of sharing of the medical record, along with the sharing of progress notes, is still anxiety-provoking.
If anyone reading this knows of medical groups who routinely share these types of test results with patients, or are patients where these results are routinely shared online, please post your experiences in the comments.
If you are not getting access to these results routinely in your care and you would like to get them, what would you tell your care team/health system to help them understand the benefit to your care and your health? Here’s what the author of the post on the Disruptive Women in Health Care blog had to say:
Although we may not think it’s our responsibility to read our operative report or a pathology report… it could mean the difference between a good or bad result in the best case scenario, or life and death in the worst case scenario. In the end, your health information is just that…..yours. No one will care more about it, or own it, in quite the same way as you.
Now Reading: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results
July 1st, 2009 | Popularity: 8% 7 comments
This is a wonderful and well-timed study that has significant implications in the era of the Electronic Health Record and the Personal Health Record. As well done as it was, I would have loved a section of inquiry to be added about “the impact of patient and family access on test result notification.” Read on…
It’s impressive that in 2009, believe it or not, there really aren’t firmly established processes for handling information about test results. A lot of what is done today is bred from custom, such as the infamous “no news is good news,” which the authors found was the protocol in 8 out of 19 medical practices studied. Everyone who likes this approach to test result notification, please raise your hand….
With that background the study team started at a very low baseline, thinking about what kinds of test results patients should be informed about, in what period of time they should be informed about them, and then analyzed medical records (5305 in all) to see if theoretical best practices were carried out., and about 7.1% of the time, on average (up to 26.2% in one Academic Medical Center practice), information to patients was not furnished about their abnormal test results. We can imagine what that might mean in a practice whose policy is “no news is good news.”
The authors looked at the impact of having an electronic medical record and found that practices with a “full” electronic medical record were no more likely to have gaps than one without IF they had a good process for managing test results. So, process and workflow trumps technology in this case.
What’s missing in good process?
So, the number of abnormal test results in this study not communicated to patients is alarmingly high. At the same time, I immediately drifted to what’s missing in the process. The authors listed these steps as a good way to manage test results:
- All results are routed to the responsible physician
- The physician signs off on all results
- The practice informs patients of all results, normal and abnormal, at least in general terms
- The practice documents that the patient has been informed
- Patients are told to call after a certain time interval if they have not been notified of their results.
Maybe this is good practice today, but what do our patients and families want in the era of the personal health record and full transparency (73 cents style)? How about this:
Good process for managing test results, patients and families at the center
- All results are routed to the responsible physician and the patient and their proxies, if specified, at the same time
- The physician and the patient and their proxies, if specified, sign off on all results (in a current PHR installation, this might mean verification that the patient has viewed the result…read on)
- The practice informs patients and their proxies, if specified, of the meaning of all results, with specific recommendations to be made based on the information
- The practice documents the shared decision made by the responsible physician and the patient based on the information obtained from results
- Without 1-4 above, the practice reaches out to the patient via the most appropriate means (letter, telephone, secure e-mail) to achieve notification and shared decision-making.
If we think about it – in the era of the personal health record, do we really want to tell patients if they haven’t heard something within a certain time interval, they should call us?
Do we really want to continue a “no news is good news” policy, at the risk of “no news” meaning 7.1% of the time someone may be hurt in the process of care?
I think it’s important to remember that the ultimate reason a test of any kind is ordered in health care is for one reason – “to reduce uncertainty.”
It would be great in a future study to analyze the impact of patients having access to their test results in real-time or near-real time, to see what the rate of failure is, and also dig deeper, at the rate of understanding of what test results mean. This is the sweet spot for physicians and nurses, who excel at using test results to reduce uncertainty in the context of a patient’s overall health.
In terms of whether or not the new/improved “Good process” is more time intensive or not than the regular “Good Process,” I don’t think it is more time intensive. I think this is a great item for discussion in the comments. Let’s talk about the cost-benefit of doing things differently.
It’s worth noting that in the first quarter of 2009 alone, 5,078,442 test results were viewed by Kaiser Permanente patients and/o their proxy individuals on KP’s My Health Manager personal health record. In many of those instances, the test results were delivered to the patient at the same time as the physician. That’s a lot of experience both to tap into, and to understand that the old process is already changed forever for lots of Americans and the teams who care for them.
With thanks to the authors for a timely and useful investigation into an area of health care where we all want to improve.
“What on earth is the rationale there?” : Prohibition on sharing test results with patients online in California
January 21st, 2009 | Popularity: 37% 8 commentsThe question asked in the title of this post is one I have as well, so I’ve decided to ask it in this post.
It was posed by e-Patient Dave in a comment on this post illustrating the challenge of test result sharing with patients today.
He’s referring to California Health and Safety Code Section 123148 , which makes it illegal to share certain kinds of test results with patients online. It also says:
In the event that a health care professional arranges for the provision of test results by Internet posting or other electronic manner, the results shall be delivered to a patient in a reasonable time period, but only after the results have been reviewed by the health care professional.
Knowing what we know about health care, reasonable time period and “only after the results have been reviewed” may be in conflict.
I understand this law was passed in 2002, so in 2009, I’d like to ask patients and those who care for them what they know of the rationale here? If you do not live in California, is there any such legislation in your state? If this law no longer existed, can people envision what the harms (and benefits) would be?
30Rock: How Test Results Can Go Wrong
January 10th, 2009 | Popularity: 32% 4 commentsSee how many different aspects of this experience could be improved (security, privacy, confidence, accuracy) if the patient had online access to their results, linked to explanatory health information and interaction with their care team at their convenience.
While the situation is obviously a parody, it seems to have enough elements of truth in it that I wonder if the writer experienced receiving test results recently. Without overanalyzing, I would say that the piece does a great job of showing the impact of disempowerment. Thanks to the 30 Rock team for the great example.
In California, a patient wouldn’t have a choice except to receive the results via telephone or in person, because it’s been illegal since 2002 to share pathology results with patients over the Internet, even if the patient and/or the doctor wish them to be communicated that way.
A Few Reflections from the National Health Information Network Forum
December 18th, 2008 | Popularity: 26% 0 comments | Leave a replyOne of the great advantages of living in Washington, DC, is access to lots of great (and affordable) learning opportunities, and this week’s National Health Information Network Forum was one of them.
The most important thing I learned is that there is one (a NHIN), and through the days’ demonstrations that progress is being made. I should qualify my comments with the fact that a good family practitioner knows what they don’t know, and this part of HIT is not central to my area of expertise, which is more focused on interactions closer to patients and providers in large heathcare systems.
In any event, I livetweeted my impressions on the fly, which you can read here, and will add some bullet points:
- As a learning session, the Forum was executed really well. Scripts were prepared and there were teams of people accessing live systems on the side (see photographs) while panelists described what was going on.
- A bright spot for me was to learn (more) about our Surgeon General’s Family History Initiative . It is going to enter a “2.0″ stage in January, 2009, and seems to have all of the abilities that could make this very simple genetic test (family history) more widely available in health care, including being open-source based, brandable, and based on standards. I especially applaud this effort because one of the great things about family history is that it is a test that involves listening to patients – the act of obtaining the information as well as using it is therapeutic in my opinion.
- I got to see some of the use cases I have studied, like the Consumer Empowerment Use Case, acted out using real systems. The patient experience was followed from PHR through to physician’s office through to NHIN and back. This was impressive.
- I saw a session on the Emergency Responder Use Case which did not cover the area that I’ve had a little bit of interest in on the personal health record side of things, the times when the responder encounters someone who cannot provide identifying information. As I have discussed previously, this is an area where personal health records linked to other identifying information (consented to by the patient) such as vehicle identification number or employee identification, may improve the ability to provide care in emergency situations. Beyond that specific situation, however, interagency/provider connections were demonstrated well.
- I saw good demonstrations of health information exchange across various boundaries. It would be interesting to see some of these great projects in the communities where they are being used.
- It would be great in the future if there were unaffiliated patients on panels, and if groups also talked about how they involved patients in the development of their work.
Overall, I am very thankful for the generosity of our Department of Health and Human Services for putting this public forum together. Many of the comments and thinking were well received by me, such as Secretary Mike Leavitt’s comment that the days of test results delivered at the convenience of the physician should end.
Photos at the top of this post, click on any to see larger.
California Health And Safety Code Section 123148 – Limits on sharing test result information with patients online
December 14th, 2008 | Popularity: 22% 2 comments- California Health And Safety Code Section 123148 – Limits on sharing test result information with patients online – Text of the law in California regarding transmission of test results online. I referred to this in the article I wrote about sharing health information with patients.
Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies | Wiljer | Journal of Medical Internet Research
November 25th, 2008 | Popularity: 16% 0 comments | Leave a replyMost participants agreed that access to the EHR is a fundamental patient right and that the implementation of PAEHRs should not be delayed.
There was also an important discussion and debate about when results should be provided—in real-time, after physician approval, or after a specified time delay. A balance must be struck between making the information available to patients in a timely fashion that supports self-managed care and patient safety so that patients are not unduly stressed by complex and ambiguous information. However, it is evident that the health care community is currently divided on this issue.
“We’re More Aware of People’s Time”: Seeing the impact of an integrated personal health record at Kaiser Permanente Georgia
November 13th, 2008 | Popularity: 25% 3 comments
Glenlake Medical Office, Kaiser Permanente Georgia Region
Crescent Medical Office, Kaiser Permanente Georgia Region
Yesterday was day 2 of 2 of my Gemba walk at Kaiser Permanente, Georgia Region.
The quote in the title of the post came from Pearl Spencer, RN, when I asked her what the impact was of real-time delivery of most test results to patients via their personal health record (My Health Manager, on kp.org) which is the case within this health system.
Prior to the advent of the personal health record, when a patient was being seen in the medical office and needed a lab test, the test would be ordered, they would go to the lab, and then they would come back to the waiting room, to be called back in when the test was completed and the physician was ready to see them.
Now, because tests are shared with patients on kp.org in real-time, some are finding out that results are ready via “tickler” e-mails being sent to their smartphones while they are waiting, even before the physician has seen the result, because they are with another patient.
This has resulted in a change in workflow – they now advise patients up front how their health care team will respond to the questions about their test results and are prepared for a quicker turnaround, to respect the patient’s time. As Pearl said to me, in any other doctor’s office (without a personal health record), teams typically prepare for results to be delivered to patients in 3 days to several weeks. In her team, they prepare for delivery in hours, or even less.
So it’s happening – the personal health record is changing patient expectations, and health care teams are innovating in response. This finding excited me so much I tweeted it right away…. And, I got this Tweet back, from Jason Bahn, MD. I happen to love that the real life experience of a nurse serving patients using next generation tools can have such an impact.
Is there any reason that any patients in any care system shouldn’t experience this awareness of their time on the part of their care teams?
Overall, I learned a ton, and this is going to be (a) a great start to learning more and (b) great foundation for the work I will do, when I can always think about what weighs on people’s minds as I support them.
With gratitude to the members and health care teams at Southwood, Glenlake, and Crescent Medical Offices at Kaiser Permanente Georgia for the great teaching, and their medical and nursing leadership for creating the learning environment for all involved.
Delayed and Embargoed Results on PatientSite
October 4th, 2008 | Popularity: 15% 0 comments | Leave a reply- Delayed and Embargoed Results on PatientSite – Thanks to John Halamka, MD, again for opening the doors on his work at Caregroup's PatientSite. He details BIDMC's rules for sharing information with patients. I would probably argue for more liberal sharing of radiology and pathology, however, it's important that they are sharing this information routinely.
