This paper is really called “Notification of Abnormal Lab Test Results in an Electronic Medical Record: Do Any Safety Concerns Remain?” and it answers the question handily about whether safety concerns remain:
For me it also answers the question: Should patients and families have access to their lab test results?
The authors reviewed 4 key lab test results (HbA1c, HCV, TSH, and PSA) with wildly high or very significant values for a 6 month period in an institution with a modern electronic health record (Department of Veterans Affairs). They wanted to see if the EHR’s ability to give physicians/clinicians high-priority alerts in their work flow resulted in timely follow-up of these abnormal results.
The answer is, as previous studies have shown, about a 7 % (6.8) rate of lack of timely follow-up on significantly abnormal test results.
And again, no mention of the patient
With the confirmation again that EHRs and clinicians are not infallible with regard to transmitting important information to their patients – why are we depending on them solely as the safety net?
I am a fan of the researchers who continue to produce this excellent work, however, I find the following statements in the article lacking insight about solutions to these problems, which are serious:
Abnormal result follow-up, however, will occur only if electronic communication of test results (either through alerts or direct access of test result) is reviewed and acted upon by providers.
Problem with the above: patients are not included. If providers act and patients do not, then follow-up has not happened. We’re not treating lab results, we’re treating people.
High-reliability tracking systems to monitor potential patient harm and outcomes are needed, which also should account for follow-up actions by providers.
Problem, again. Does patient and family access to their health data not add reliability, and shouldn’t they be involved in what harm and good outcomes are? They, patients and families, are not mentioned anywhere as a solution to this problem. This attitude contributes to a chasm between patients and the health care system, and it’s unnecessary.
Redundant tests, too
The researchers also found that 17% of the tests with alerts were actually duplicate/unnecessary, including tests where a diagnostic test for Hepatitis C was run again, even though Hepatitis C was confirmed and diagnosed via the same test previously.
Again, how can patients with access to their own information be a part of the solution to these problems? Many ways. Let them see their test results as close to the time of resulting as possible. Bring them in to the ordering process, before the result comes back. There’s this great quote from a recent New York Times blog post (sent to me by fellow physician Jim Lewis, MD, at Kaiser Permanente) on this very issue:
Dr. Poston, an intensive care specialist, teaches medical students to begin educating patients about results even before the test is done. Patients should have realistic expectations about what results may or may not reveal, he tells students, and why some tests still take time to be analyzed. Not only will patient anxiety be somewhat alleviated, Dr. Poston said, but the role of the doctor as critical guide and partner in the patient’s care will be reinforced — even as a patient’s need to participate in decision-making will be supported.
I recently walked and talked with Peter, the CTO of the Department of Veterans Affairs, and Lygeia, at Office of National Coordinator.
Both are not clinicians, not trained in the health professions, and at the same time heavily involved in bringing patients and families their own health data.
Why is it that our patients ask for this data and not the data about the performance metrics of the aircraft they fly on? It’s simple – because health care isn’t perfect and they (and we) know it. When we get to a place where health systems can reliably deliver information that’s easy to understand, that doesn’t create safety risks, I’m confident the ePatientDave’s and Regina Holliday’s of the world would put down their tweeters and paintbrushes. They’d say, “I don’t need to be bothered with this information, I trust you, you always get it right.” Until that day comes, they’d like to help out, fill in the gaps, save themselves, the people they love, and their society from unnecessary harm. And lots and lots of physicians are going to stand with them.
Incidentally, in the first quarter of 2012, 8,462,414 lab test results have been viewed online by patients at Kaiser Permanente using My Health Manager, a double digit increase from 2011, but who’s counting 🙂
California Health and Safety Code Section 123148, which actively prevents patient access to their own data online, which should be modified, or partially repealed would be a significant step in supporting the goal of patients included in their health care.