Managing lab tests when patients view results online

A practical look at information technology issues and usage

By — Posted Aug. 27, 2012.

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Numerous surveys have found that patients want immediate access to the results of their laboratory and other diagnostic tests. In an era of transparency and patient engagement, they are getting their wish.

This immediacy has created scenarios in which patients see test results before their physicians do, or before their physicians can explain the results. This is forcing a change in the patterns of how much information doctors tell patients and when. Instead of patients coming in after a test and having the results explained to them, physicians are discussing issues such as appropriate ranges and levels before tests are even ordered.

If managed correctly, patient access to test results can lead to more meaningful discussions between physicians and patients. If managed incorrectly, patients could be subjected to bad news before their physicians can talk to them about it, or they may access results they don’t understand.

Keith Veselik, MD, director of primary care at Loyola University Health System in Chicago, found that giving patients access to test results didn’t lead to much change, except regarding workflow and patient engagement. Patients can find their results on portals operated by Loyola.

“Before the portal, you were communicating the test results in some fashion,” he said. “You’re still doing that.” Now, patients are more informed. And for knowing that patients will see the results whether they have talked to them or not has kept physicians on their toes.

How fast, and from where, patients receive their test results varies. Some patients will access their results through a patient portal. Others might access them through the lab where the tests were done. Quest Diagnostics, for example, offers patients online access to certain results.

The level of access depends on the state. John Cohen, MD, chief medical officer for Quest, said 14 states require that results go directly to physicians or that physicians give approval before results are sent to patients.

Many systems place a hold ranging from 48 hours to several days on all results, while others hold only those that show abnormalities or illnesses. Some organizations place holds depending on the test, such as pathology or x-ray.

Patient access to information is only going to grow over time, said Tom Delbanco, MD, an internist at Beth Israel Deaconess Medical Center in Boston and professor of general medicine and primary care at Harvard Medical School. So it’s something for which every physician must prepare.

“This kind of transparency is here to stay, and both patients and physicians need to learn how to deal with it,” he said.

Setting the stage

Managing patient expectations begins with ordering tests, said medical sociologist Richard Frankel, PhD, an investigator for the Regenstrief Institute, a health research and education organization in Indianapolis. He said physicians can prepare patients for bad news or alleviate their anxiety by telling them what they are looking for and whether they expect to find anything.

Patients probably will turn to the Internet for information about what they are being tested for, so physicians should direct patients to good sources, Dr. Veselik said. “Sometimes Google will send them to Joe Blow blog,” he said.

Physicians say this pre-test information should include a short lesson on acceptable ranges, depending on the test, and what is abnormal but nothing to worry about. Explaining exactly what the physician is looking for should be a big part of the conversation, Dr. Delbanco said.

Managing time

Because most systems give physicians delays of at least a few days to talk with patients about test results that may include bad news, some physicians are becoming more vigilant about looking for the results.

“If I order a chest x-ray and am very worried I may find something unpleasant in it, I will make darn sure I look at that x-ray quickly before the patient can,” Dr. Delbanco said.

But the focus doesn’t have to be on delivering bad news, Dr. Veselik said. “This isn’t going to replace an important conversation that we need to have. This is also a chance for me to compliment you on your great cholesterol profile in an easy and timely way.”

Acknowledging all test results, both good and bad, lets his patients know that if there is a more urgent outcome, there will be a timely conversation about it, Dr. Veselik said.

Safety in numbers

Dr. Delbanco said some physicians at Beth Israel feel secure in knowing that their patients are a second set of eyes on their records. Sometimes a lab result might need to be addressed, but more urgent matters dominate the conversation. Sometimes patients pick up on things their physicians miss, he said.

“In the end, what we are all worried about is a proper outcome. And the more people checking up on that, the better,” he said.

Patients also can be a source of information for physicians when they are more engaged in their health, Frankel said.

“In the era of digital information, we probably need to give patients more credit than we do,” he said. “Instead of saying, ‘No, you can’t have this information,’ we should say, ‘Here are some trusted resources, in addition to a personal conversation I might have with you, that you can look at if you have concerns.’?”

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