Sunday, November 02, 2014
Automatic Seven Day Posting Of Clinical Results To The PCEHR Proposed. The Idea Lights The Blue Touchpaper With Many Clinicians.
This appeared a few days ago.
30 October, 2014
There is "no evidence" patients will be harmed by reading pathology results on their PCEHR before speaking with their GP, a leading Australian e-health expert says.
This month, Australian Doctor revealed the plan to automatically upload pathology and diagnostic imaging results to the PCEHR after seven days — irrespective of whether the patient had been seen by their GP.
The upgrade is being sold as a major step forward in the clinical relevance of the moribund system.
But there are fears that patients will find out they have serious conditions, such as melonoma or chlamydia, by reading through the files on the PCEHR before being contacted by their GP.
The Australaisan College of Health Informatics reviewed research on various systems that allow patients access to results, systems mainly based in the US.
Published in Pulse IT, the review said: "Despite the enthusiasm for direct patient access to laboratory and imaging results, the evidence from existing evaluations of existing patient portals and their impact on the safety, effectiveness and quality of patient care is limited and inconclusive.
"There are major questions about how patients use their record and respond to their results alongside concerns about the impact on authority and responsibility within the current patient-doctor relationship."
And it said caution should be taken in generalising from the results of studies on US system.
But the informatics college said it is endorsing the seven-day delay model for the PCEHR system, which will be rolled out from next year.
Lots more here:
There are 18 comments following the article which was posted only a few days ago. Reading dispassionately I would have to suggest that the reaction to this article was fairly negative.
The article was triggered by an ACHI Press release which can be found here:
The key paragraphs are as follows:
“ACHI's review found that there was no evidence demonstrating harm and in fact early evidence to suggest some consumer benefits from access to pathology and diagnostic imaging results. "The College acknowledges however the clinical cultural issues, and endorses the suggested seven day delay," A/Prof Pearce said. The current proposal has results being posted after a seven day delay, allowing clinicians time to re-view and contact patients before they get direct access.
Dr Bain noted that the review acknowledged the concerns about the effects direct access might have on GPs" traditional role as gatekeepers and the anxiety that could be experienced by patients reading results before their busy GPs have been able to curate them. "However, for clinicians with modern health informatics systems, this should not represent a barrier to access. The alternative, that all results should be clinically curated, represents an unacceptable work load on busy GPs."
"Our review shows patients value access, but are lacking on information as to why and what patient out -comes might be," A/Prof Pearce said. "Accordingly, ACHI supports the proposed model, with appropriate safeguards. Allowing consumers direct access to pathology results is new technology and must be framed in the context of improving the quality and safety of care.
"This means working with consumers to understand access and health literacy issues as well as targeting those with chronic diseases, where regular pathology is part of the care plan."
The full review report is available on the ACHI website, www.ACHI.org.au.”
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I have to say I disagree profoundly with this.
To me what should happen is when tests are requested the patient should be asked if they want automatic access to the results. If they do, and time is taken to explain what the tests might mean, then early and quick access makes perfect sense. If not then the results should only be posted to the PCEHR once reviewed by the requesting clinician.
Taking both the patient and the clinician out of the loop - and posting automatically is just nonsense.
This is especially so when the ACHI review makes the clear point that "Despite the enthusiasm for direct patient access to laboratory and imaging results, the evidence from existing evaluations of existing patient portals and their impact on the safety, effectiveness and quality of patient care is limited and inconclusive. “
Just how a recommendation of this sort is arrived at in the absence of firm evidence of significant benefit is beyond me!
It only takes on suicide of one patient - following misinterpretation of a result they have not asked to have access to - as almost happened with a patient seeing the report of a brain scan - and the finger pointing and blame game would be a wonder to behold.
Bottom line to me is get the patient to agree to access and then risks of harm are dramatically reduced - otherwise try and make the PCEHR sufficiently useable that GP curation of results is easy, quick and painless.
Patient consent and involvement - and not a fixed time limit to post results - is what matters here!
All this haste is, I suspect, is a last gasp, rear guard action to make the PCEHR relevant and this auto-posting without explicit consent approach is badly flawed in my view.
Posted by Dr David More MB PhD FACHI at Sunday, November 02, 2014