Publishing Test Results in Patient Portals: Holding a Tiger by the Tail

Pathology Informatics 2012 was held last week in Chicago. All of the lecture PowerPoint slides have been posted and are available online (see: Full Schedule). Click on any of the lecture titles to launch the presentation. in this and subsequent notes, I will frequently link to this rich set of lectures to support some of the new ideas that have been germinating in my mind post-conference. --BAF

Alexis Carter delivered an excellent lecture at the recently completed Pathology Informatics 2012 conference in Chicago about publishing test results via patient portals (see: Patient Portals For Laboratory Results: Conundrums and Care). Such patient portals are a requirement of Stage 2 of the HITECH act and Meaningful Use (MU) (see: Relevance of Meaningful Use Rules for Lab Professionals). Here are some more details regarding this MU requirement (see: Meaningful Use Stage 2 and Patient Portals):

Physician offices barely began to pass Stage 1 of Meaningful Use requirements before it was time to gear up for Stage 2 Meaningful Use, where a key proposed requirement is to increase the electronic information shared with patients....David Rowe, global director of Product Marketing at GE Healthcare IT, remarks, “We’ve had a patient portal for more than 10 years, but it was dormant until Meaningful Use reawakened that marketplace.  It’s a way for physician to provide patient information easily and quickly....Patient portals help physicians meet two proposed core measures of Stage 2. The first measure requires providing a clinical visit summary to at least half of your patients within three business days. The second measure requires physicians to electronically provide lab results, medication lists and the like to patients upon request.

During her lecture, Alexis discussed some of the challenges regarding access to lab test results by patients. I concur with her completely. We in the world of pathology have not yet completely mastered the task of displaying test results to physicians but are now embarking on a similar task for patients. Alexis alluded to the problems that occur when patients discover abnormal significant test results that may not have been acted upon by their physicians. Putting aside medicolegal complications, we should perhaps "reward" patients who comb their electronic records for such anomalies. Through their discovery, we are potentially avoiding subsequent complications.

Patients have heretofore supplemented the inadequacies of our hospital record-keeping system. Everyone can sympathize with patients who, on being interviewed by a medical specialist on referral, are asked which physicians they have previously seen and what they were told. It has been claimed that our expensive EHRs will now solve such problems. Indeed, they are beginning to deliver on this promise by providing patients access to lab test results.

The problem of displaying lab test results for patients in the patient portal is even more complicated than their acquisition and storage in the LIS. Recall that we use HL7 interfaces to copy results to the EHR and subsequently to the patient portal server. Recall also that such interfaces act as what Ulysses Balis has called a data shredder, deconstructing the formatting that we have carefully developed over decades on our LISs. Additional errors can be introduced when test results are passed from the EHR to the patient portal. 

Lab professionals thus need to continuously monitor and manage how test results are displayed in both the EHR and the patient portal. I am not complaining about patient portals. They provide very useful information for patients that never would have occurred without HITECH and the penalties for non-compliance. All that I am saying is that we will need more lab personnel to monitor these result reporting channels for errors and for the investigation of the causes of such errors.

Comments

[Grahame Grieve]

The problem of shredding is very serious, and portals shouldn't try to reconstruct reports from atomic data. In Australia, all diagnostic reports are supposed to have a final OBX that contains the report for presentation (Australian Standard AS 4700.2:2007 + others). It's this representation that would be appropriate in patient portals. In the absence of such arrangements, patient portals will be unsafe.