Wednesday, November 19, 2014

Position Paper - Clinical Results In The PCEHR. A Good Idea Or Not? - Draft For Comments.

This paper considers the place of holding diagnostic investigation information in the PCEHR. Before reviewing the proposition there are some assumptions which may or may not be true and need to be surfaced.
These include:
1. That there is a demonstrable benefit of holding diagnostic results in the PCEHR to be accessed by providers and consumers.
2. That diagnostic results can be safely and accurately displayed to relevant users.
3. That navigation and search for results, as well as trend information presentation, is much improved.
4. That overall the ease of use of the PCEHR is improved and that there is a commitment to ongoing support for continuing improvement of all aspects of the system.
5.  That all operational, security, information integrity and privacy issues can be resolved.
I will leave it to the reader to decide the their position on the truth of these claims.
Issues To Be Addressed.
Once and if it is decided it is reasonable, sensible, justifiable and beneficial to load results into the PCEHR the next issue to be considered is what is required of the process.
On the face of it the following are important:
1. The timing of result transmission to the PCEHR.
2. The mode of storage of the information.
3. The mode of presentation of the information is suitable for both professional and consumer use.
4. That there be at least some level of consumer decision to assist understanding (maybe a help line etc.)
5. Avoidance of consumer anxiety while making it easy for the sophisticated / experienced user to benefit from results.
I think it is arguable these issues can be addressed by adopting the following approach.
How Should It All Work?
On the assumption that it is generally agreed results information in the PCEHR is a good and worthy idea, and assuming that the contents of one’s PCEHR should be controlled by the individual, as the name of the PCEHR implies then it seems this has to be the way things happen.
1. Treating clinician decides on need for investigation.
2. Investigation ordered and patient asked if they want results uploaded to PCEHR when finalised, at this point the clinician can discuss with patient what they are looking for and what potential results might mean. (This can be a simple tick box, to approve upload, on the request form which the information provider then actions when results are finalised)
3. Patient says fine and results are uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
4. Patient says no and results are not uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
Why can’t it all be just this simple?
A poll finalised today made it clear readers also believe consent to upload of results should be obtained before it happens.
See here:
Of course there are some other approaches available - especially if the PCEHR is taken out of the equation or treated as the secondary system it is. Ideas like having the information provider provide access directly on authorised patient request or having a tick box which results in the results being sent to the patient on request might be considered.
There are all sorts of more radical things which might be possible, for example, the patient being given a digital key when the test is done and then being e-mailed an encrypted result when it is available.
Overall I believe that placing test results in the PCEHR is being pushed because the PCEHR exists and is looking for a reason for existence rather than because use of the PCEHR is the best way to provide patients with access to their results. Maybe some thinking outside the square might be useful.

1 comment:

Anton Knieriemen said...

It is a pity that the PCEHR has not benefited from an incubation and evolution in the wild but seems to be bred in a lab.