At the beginning of the LIS era more than four decades ago, lab result reporting was relatively simple. Test results were printed for clinicians from the LIS accompanied by their reference ranges. The latter have always been an essential component of lab reports because they vary according to the test methodology or analyzer. Additional test information was stored in the LIS for each result such as the name of the ordering physician, the date/time ordered, the date/time reported, and the performing lab. I commonly refer to all of this test result information as the provenance of the result, an analogy to the world of antiques where the provenance is a record of ownership of a work and used as a guide to authenticity or quality of a piece.
We are entering an era in which it now begins to make sense to refer to the diagnostic results package (DRP) instead of test results for patients. This broader term for a patient's combined diagnostic results becomes particularly relevant as we pursue integrated diagnostics. This new approach to reporting was covered recently in an article in CAP Today: Integrating AP and radiology, inch by inch. I have also blogged extensively about the same topic (see, for example: Ten Reasons for Merging Pathology/Lab Medicine with Radiology; Revisiting Integrated Diagnostics and the Integrated Diagnostic Report; Development of Integrated Diagnostic Servers by Pathology and Radiology; XIFIN and vRad Partner to Pursue an Integrated Diagnostics Business Model). Much of the success of integrated diagnostics will hinge on the goal of coordinating and integrating all pathology and radiology results. Diagnosticians will be asked to "predigest" (i.e., integrate) all of the results that they generate, providing greater guidance to the test-ordering clinicians and enabling them to work more efficiently.
In order to better understand the DRP, consider the example of a patent with complex cancer and other molecular studies. The total "package" of diagnostic results for the patient would also include surgical pathology, cytopathology reports, and imaging studies. Not common now but perhaps more prevalent in the future, this set of test results may be forwarded to diagnostic consultants working in other hospitals who would attach their interpretive reports to the results "package" before returning it to the home hospital. Although some of the responsibility and work for maintaining a patient's results package would be by algorithms, some would require the attention of pathologist and radiologists.
The DRP at its most basic level would consist of an index of all diagnostic tests and procedures performed for a patient across time and at various facilities. Any or all of the results could be retrieved on demand by clinicians. At any time, it would also be possible to slice-and-dice these results data to obtain the most relevant diagnostic picture at the time. The data could thus be viewed by date, by care episode, by hospital, or even by by diagnosis. This latter view would be the most challenging to organize because there would be a subjectivity in determining which tests and procedures contributed to any particular diagnosis. I envision the tools for maintaining the DRP as being an essential component of a new generation of LISs.