Electronic Communication of Pathology Results

Dr. Ray Lin Department of the Department of Laboratory Medicine, National University Hospital at Singapore, has called my attention to a white paper published by the Royal College of Pathologists of Australia in November 2006 entitled Electronic Communication of Pathology Results. It's a short but fascinating document. I have copied the key elements of it below.

VIEWING OF RESULTS

1. Results must be displayed in their full context in order to allow proper interpretation.
2. Wherever numeric pathology results are displayed, the relevant units of measurement and reference intervals must be simultaneously visible at all times. It is not adequate to provide access to this information through daughter windows in such a way that viewing it becomes discretionary.
3. Any textual comments issued with a report must be displayed before a viewer can exit from a result enquiry session.
4. Viewers must not have the capability to modify the result display in such a way that units of reference, reference intervals or textual comments can be omitted. Systems should incorporate the option to freeze the units of measurement and reference interval column(s) if the user wishes to scroll through cumulative results.
5. Electronic results displays must include a function that enables the viewer to identify clearly where a test was performed.
6. Where results from different pathology services are displayed adjacent to one another (e.g. in an Electronic Health Record), there must be a flag to indicate that this difference should be considered when interpreting and comparing the results.

GUARANTEEING OF RESULTS

1. The College does not support the truncation or modification of pathology reports following release by a pathology service for the purposes of electronic display formats.
2. As electronic systems may be beyond the control of the pathology service, results transmitted electronically should only be guaranteed if they have been 'rendered for display' and are not therefore subject to modification.
3. If ‘atomic results’ are transmitted, the pathology service should advise that whilst the integrity of individual results is guaranteed, no responsibility is accepted for the manner in which the results are displayed following transmission, and using or displaying results in
an incomplete manner is not supported.

This white paper by the Royal College of Pathologists of Australia concerning Electronic Communication of Pathology Results is both clearly written and extremely relevant to lab operations in the U.S. today because test results from LISs are commonly replicated to electronic medical records (EMRs) in hospitals. These EMRs then become the primary reporting vehicle for the labs to physicians. I was impressed with the very clever use of terms in the report such as "atomic results," which I take to mean replicated test results that are stripped of important accompanying data such as the test reporting units or reference ranges.

My first instinct after reading this document was to suggest that all of the U.S. pathology professionals societies should adopt a similar or identical set of recommendations for use in this country. However, it also occurred to me that there may be few if any EMRs running in large U.S. health systems that would be actually compliant with these recommendations. Given that some of the major U.S. EMR vendors also have installations in Australia, this thought made me wonder if all of the Australian EMRs are compliant with the recommendations or whether they were published as a suitable HIT goal for vendors to work toward. Perhaps someone from Australia could respond to this question.