More on Lab Communication with Test-Ordering Physicians and Nurses

In a recent note (see: Need for Improved Communication Channels between Clinical Labs and Users), I addressed the issue of optimizing lab communications with clinicians and the desirability of formally integrating such activities into the job descriptions of lab personnel. As a comment, Branko Perunovic, submitted the following:

Thanks for the post, this is a relevant and often revisited topic. Our team at Laboratory Medicine at Sheffield Teaching Hospitals, UK, is prototyping eConsult, in-house developed software bolt-on the electronic requesting and LIMS system that enables questions and successive answers in relation to the particular case/episode becoming a part of the patient record (and avoid disruptive phone enquirers, repeated questions as the patient moves through the system and learning about the recurrent issues/gaps in education that need to be addressed in a systematic way. The prototype rolled out in the hospital and will extend to primary care and outreach sites. Due to other type of legacies, not able to include mobile devices. A quick overview will be published in the next RCPath Bulletin.

 

This is a very good idea from Branko and his team in Sheffield, UK: integrate questions to lab experts and the subsequent answers (I assume written) into the electronic medical record for documentation of the process and later reference. As I continue to ponder the issue of how to improve lab consultation with users, I have come up with the following hierarchy of various clinician/lab user ranging from the least formal (and possibly at times the least effective) to the most effective:

• Curbside consultations by clinicians with colleagues.
• Textbooks and relevant journal articles.
• On-line or hard-copy lab directory/handbook.
• Telephone/cell phone calls to lab personnel requesting information and help.
• Apps such as that described above by Branko Perunovic that reflect communication with the lab personnel but also create a discussion thread that is integrated into the LIS/EHR.
• Formal lab consultations with lab experts culminating in a formal report entered into the electronic medical record.

Readers will recognize this last process as reflecting the goals of Diagnostic Management Teams (DMTs). This was an idea hatched and promoted by Dr. Michael Laposata (see: The what and why of diagnostic management teams; Innovative Pathologists and Clinical Laboratory Scientists Use Diagnostic Management Teams to Support Physicians with More Accurate, Faster Diagnoses; The Importance of Forming a Diagnostic Management Team). Dr. Laposata will be presenting a webinar on DMTs on November 29 as part of the API/Sunquest series on pathology informatics topics.

Comments

[Jonathan Horan]

This is really topical right now among the lab. At a lab executives' roundtable I arranged at the AACC this year, the issue of communication came up. We discussed the frustration of family doctors ordering tests that could be duplicate or inappropriate and how the lab might be more proactive in optimizing two ends of the spectrum: the orders transmitted to the lab and the interpretation of the results sent back. Participants felt that there needed to be a sort of "conversation" between the lab and the ordering physician - probably mediated with some combination of middleware/LIMS/EHR. It all came down to communication and how the laboratory is somewhat isolated in its current function, and how improving it is central to becoming part of a value-based care system.