While the automatic sharing of lab test results with patients online is becoming more commonplace, sharing imaging / radiology results / reports is still controversial.
And if you read carefully in various regulations, imaging results are often called out separately that lab test results for sharing with patients and families, which is more of a distinction created by the medical profession than by patients.
The literature shows (see link above) that patients don’t come to health care saying, “my imaging test results and lab test results are two different things, please only share lab test results with me.”
With this history in mind, it’s worth mentioning that Group Health Cooperative (@GroupHealth), who seem to be on an innovation streak these days, or actually most days* (see: The mHealth app from @GroupHealth promotes what people want : A relationship with their doctor) has been sharing imaging test results along with lab test results with its members since June 23, 2011. This is a big leap both because these results are available to be seen by members and families, and because they are automatically shared – previously, and in most systems, physicians need to click a button for this sharing to happen, which delays access.
*happy disclosure: Group Health Physicians are a Permanente Medical Group affiliated with The Permanente Federation
I asked John Kaschko, MD, from Group Health a few questions about how things are going, and he kindly wrote this summary for me:
As you read through this, note how they are changing the way they do things, to make them more accurate and enhancing of communication between patients and doctors, based on this experience.
Also just think about how this is transforming medical practice – a radiologist, sitting in front of an electronic viewbox, using their experience and judgement to narrate the features of an imaging study, is now doing this with the understanding that the report they generate will be read by the very people they are talking about in the dictaphone, the patient (and their family). That’s pretty big.
Thanks John and Group Health for the information and experience. Feel free to chat them up via their Twitter handle: @GroupHealth and/or add your comments and impressions (pun intended) below.
On your question: “Could I get a few paragraphs from one of the docs about how imaging results sharing has gone – is it 100% perfect? Have there been any issues? Do you share the entire report or just parts, and in real time or a delay? “
Generally it’s gone reasonably well, no significant issues with providers complaining about the release, “I’m getting too many questions, etc Our providers were manually releasing through the “MyGH Done” button about 20% of reports prior to going live with this automated release, so releasing these was not a foreign concept to many.
We are only sharing a portion of the report, the “Impression” field in Epic, not the “Result Narrative” – Currently sharing plain films, mammos and DXAs – 2 day delay on plain films and DXAs, 7 days on mammos.
It hasn’t been 100% perfect.
The two issues that have come up are:
1) on mammogram results, when a biopsy is done, the report gets addended with the pathology report. We were initially releasing all mammo reports at 2 days…which meant (since pathology comes back in 2 days) that when the pathology information was added, the patient could see the path results before staff had a chance to contact them. We addressed this quickly by changing the release for mammos to 7 days rather than 2.
2) The other issue is about 20% of our reports are showing up “blank” to patients. This is related to just sharing the Impression part of the report and not the entire report, we have a workflow/interface issue that is causing this. In order to get part of the radiology report into the Result Narrative and part into the Impression, this requires that the Radiologist always say the word “Impression” in his/her report. That gets recognized in the interface and everything subsequent gets put into the “Impression” field (and everything before into Result Narrative). If the radiologist says “Summary” or “Final Result”- these words are not recognized in the interface and the Impession field ends up blank (the entire report is in the Result Narrative field). Radiology is attempting to standardize the process/language used to improve this but it still requires a manual step.
We are debating whether to simply release the entire report. Hope this helps. JK
Oh one more thing, to people who say, “but patients won’t understand what’s in those reports,” here’s a tweet-versation from two Group Health physicians that shows what happens in a system where sharing with patients is the priority.