This was released a day or so ago.
GPs and pathologists raise concerns over plans to remove 7-day delay for all pathology results on My Health Record
Royal Australian College of GPs and Royal College of Pathologists of Australasia
The Royal College of Pathologists of Australasia (RCPA) and the Royal Australian College of General Practitioners (RACGP) have warned the Government’s proposal to remove the 7-day delay for all pathology and diagnostic imaging reports on My Health Record may lead to misinformation and patient distress.
Both the RCPA and RACGP support sharing healthcare data with patients, but want the current 7-day delay for tests not already available in real time to remain in place. This allows doctors to help patients understand and interpret results in a safe and caring setting. The colleges also request the Government include them in any future consultation.
President of the RCPA, Associate Professor Trishe Leong, said patients should review results with a specialist.
“The RCPA believes that patients should be fully engaged in managing their care, and access to diagnostic information is part of that management,” Associate Professor Leong said.
“We therefore support the sharing of information without barriers to access, such as the 7-day rule, overall. However, it is critical that if these delays are removed, consumers are advised to review their results with their GP or other specialist and are also provided with evidence-based information on pathology testing such as Pathology Tests Explained, and contact details for general support services, such as GPs and Lifeline.
“Whilst the RCPA acknowledges that there is potential for improved care through the quicker provision of results and less patient anxiety, we must consider the unintended consequences of a patient failing to return for a clinical appointment because results are within the normal range or misinterpreted. This significantly impacts patient care and requires a system for monitoring. Similarly, the impact on healthcare providers needs to be considered, with increased communication from patients to the referring healthcare providers or directly to the laboratories, wanting to know the meaning of an unexpected abnormal result.”
Currently, patients must wait seven days before they can access most pathology and diagnostic imaging reports that have been shared to My Health Record. This delay allows healthcare providers to review and schedule appropriate follow-up with their patients.
Under the proposed changes, the 7-day delay will be removed for all pathology and diagnostic imaging reports, meaning patients will be able to access results as soon as they are shared to My Health Record.
RACGP President Dr Nicole Higgins said the delay gives GPs and patients a vital opportunity to discuss results.
“We strongly support patients having access to their results and medical history,” Dr Higgins said.
“GPs and other specialists don’t seek to be medical gatekeepers, but we are there to support our patients to understand their results, treatment options and next steps. The 7-day delay gives us and our patients time to make an appointment where we can sit down and have those important conversations.
“Much of the terminology entered into My Health Record, is written for doctors, by doctors, and has to be understood in the context of a patient’s medical history and other health factors and conditions. Patients often get good insights and find support by looking into their results, but it’s important they know what their results mean for them. That’s the value of having a usual GP.
“A pathology result can be stressful, so there’s real value to having a two-way discussion with a trusted medical professional. There is also a worrying amount of vague, unapplicable, and outrightly incorrect information online. Patients who have worked with a doctor to understand their health are better supported to know what information applies to them, and what doesn’t.
“If this change does go ahead, at the minimum it should not happen without an education campaign for patients so they can understand the risks of interpreting their own results. There will need to be clear advice in the My Health Record advising patients to discuss results with their doctor.”
Both colleges recommend some diagnostic tests are considered for exclusion if the 7 day rule is removed. This includes anatomical pathology and cytopathology reports, which are often discussed at multidisciplinary team meetings to determine an appropriate clinical path, and genetic test results which often carry broader, more long-term, and more complex implications than other pathology results.
“Anatomical pathology and cytopathology reports can be very complex, and consideration is required as to whether their immediate release is in the consumers’ best interest,” Associate Professor Leong said.
“Genetic test results are often probabilistic, have consequences for family members, have potential psychological impacts, can have unanticipated implications, and vary in their actionability and therapeutic options. Post-test counselling is therefore considered crucial to prevent potential patient harm from specific genetic tests and results.
“Pathologists and requesting doctors are best placed to determine when specific genetic tests or results require post-test counselling. To allow for such counselling, providers should have the discretion to delay releasing results for up to seven days when clinically warranted.”
Noting that there will be exceptions to immediate publication to My Health Record, the RCPA and RACGP recommend that there is broad consultation on the exceptions. The colleges request that they are a partner in those consultations with Government to ensure there is appropriate oversight and governance of these decisions.
About the RACGP
The Royal Australian College of General Practitioners (RACGP) is the peak representative organisation for general practice, the backbone of Australia’s health system. We set the standards for general practice, facilitate lifelong learning for GPs, connect the general practice community, and advocate for better health and wellbeing for all Australians.
Visit www.racgp.org.au.
About the Royal College of Pathologists of Australasia (RCPA):
The RCPA is the leading professional organisation representing pathologists, medical specialists and scientists who provide pathology testing in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.
For further information on the RCPA, please visit www.rcpa.edu.au or see updates on Facebook - @PathologyRCPA, X (Formerly Twitter) - @RCPAPresident, @PathologyRCPA, or Instagram - @the_rcpa #RCPA #pathology #MedicineIsPathology.
Media contacts:
John Ronan
Media Adviser
Ally Francis
Media Adviser
Stuart Winthrope
Media Officer
Contact: 03 8699 0992 / media@racgp.org.au
Follow us on Twitter: @RACGP and Facebook.
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The position stated above is more than sensible and will minimize worry among patients by making sure results that are concerning are able to be explained by the patient’s doctor to the patient.
David.
11 comments:
The push to make test results immediately available on My Health Record is political and is an attempt to boost its use. Rather like making it opt-out, which does not appear to have had much effect.
The government should listen to those who actually know about, and deliver healthcare and shelve this proposal.
However, it is more likely that political imperatives will win out, once again reinforcing the view that My Health Record has nothing to do with healthcare.
These days, having failed to deliver anything like the promises made about My Health Record, the politicians and public servants are looking to save face, whatever the cost, financially or to patients and professionals
As it ever was.
Have to agree David. Probably being driven by the underlying themes in this new blueprint that is underpinned by the usual “consumer wants blah” and some % graphs is the safe zone (65% to 85%). The new fashion of real-time data analytics and such I am sure is also fuelling the fire. You start having these ChatGPT type tools doing diagnostics at home - Dr Google on Steroids.
Immediate release to My Health Record:
Ca Pancreas
Stage IV Malignant Melanoma
Oat Cell Ca Inferior Lobe Left Lung
...... I do hope these patients will cope when they read these diagnoses in their MHR!
A patient that gets that diagnosis in their MyHR isn’t going to be surprised any are they?
Much of the commentary about this is pretty shallow. There are two questions:
* In what circumstances does embargoing the results for 7 days so the GP *might* call the patient first avoid negative outcomes?
* In what circumstances does embargoing the results for 7 days so the GP *might* call the patient lead to negative outcomes?
Like, what actual circumstances? When is a patient going to get a result that they’re sufficiently distressed by to create more anxiety than waiting for 7 days to hear from a GP that never calls? Did the GP order a cancer test out of the blue without any reason from the patient’s perspective? I think that the cirumstances where this happens are actually pretty narrow
For instance, there’s probably a band of cognition impairment where the patient is sufficiently cognitively impaired that they aren’t prepared by the GP’s explanation of why they test is happening, but they’re still cognitively capable of being distressed by the report. I think that’s a pretty narrow band. My parents and parents in law are not quite in that band yet, but I think they’ll blow through it pretty quick, and we’re already at the point of making sure someone is there with them in the doctor’s room to make sure that misunderstandings don’t arise. So how much of a concern is that really?
Otherwise, as far as I can see, there’s a clear implication of *surprise* at play here - the patient got a distressing report that they were not prepared for. Under what circumstances does that surprise arise? The obvious example for me is an incidental finding on something like a chest x-ray, a radiologist finding a bone cancer. This certainly happens, but if you’ve ever read one of those reports it’s pretty carefully expressed in language most patient’s won’t really understand anyway. “An area of increased mass was observed in one of the ribs. Suggest further investigation.” (alright, sometimes it’s more strongly stated, but not often, in my experience)
So I suspect that the circumstances where this is a problem are pretty narrow. There’s a working party already to decide which reports should continue to be embargoed, and maybe the time should increase for them - histopath, cytogenetics, genetic reports. Maybe we should just say, they don’t go in the myHR at all?
On the other hand, things like INR, basic metabolic status, hemostasis… these are perfectly useless seven days later, and they should be released immedately. Particularly INRs for warfarin. That seems like a super no-brainer to me, and I have relatives who need to know the results ASAP, and get super frustrated by playing telephone tag with their GP for days…. the height of stupid in 2023.
So I don’t really understand the clinical concern here - overseas research supports immediate release of most reports, the parties have already agreed to decide what not to do that for…. so what’s driving all this in the media? did someone have to much to drink for xmas?
Calls into question - just who is looking at the MyHR?
Fair Statement Jan 13 @ 8:07 PM. As is the statement on Jan 14 at 8:39 AM. No solution will be optimal for all. I guess this is where the ADHA and its experiment fall flat for me. The system is touted as the answer for all. For me, it’s a solution unable to find a problem; however, its continued forced existence creates problems—a few viewpoints short IMHO.
did someone have to much to drink for xmas? probably could have left that out of what was a reasonable position. Made me wonder if the whole effort was more “better to kiss than bite hand that feeds” - just saying with respect.
@January 13, 2024 8:07 PM
"On the other hand, things like INR, basic metabolic status, hemostasis… these are perfectly useless seven days later, and they should be released immedately."
Are you seriously suggesting that the only way to access test results is via MyHR? That the whole healthcare business is totally dependent on MyHR?
Get real.
> Are you seriously suggesting that the only way to access test results is via MyHR? That the whole healthcare business is totally dependent on MyHR?
no, of course not. But accessing diagnostic results via the MyHR is a useful thing for it to do. How else to get it? Well, some GPs will email you, and some will call, but all GPs are way over-busy, and as far as I know, direct delivery via the MyHR is the best working way for patients to get their results directly without the GP being an intermediary. Please correct me if I’m wrong
> probably could have left that out of what was a reasonable position
Yes I should’ve lef it out. "better to kiss than bite hand that feeds”.. well, DOHA is now paying me for advice, though not on this particular subject directly
> For me, it’s a solution unable to find a problem;
by and large that is the case - we have spent more than a decade trying to force it to be useful. But I think in providing direct access to results, we’re trying to make it *actually* useful for a change. Every little bit helps, and even if you think it’s not enough, it’s better than nothing
These are two very different issues.
1. Should all reports be delayed by 7 days?
2. Should the only way to share reports be through MHR?
There is a raft of research showing that the vast majority of reports being immediately made available to patients is a good thing, especially from a patient perspective.
I doubt many think (2) is a good idea.
Many path labs can provide access to your test results. Some choose not to because they believe you should see your doctor first.
Why not enable all path labs to provide browser access to anyone they test?
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