Saturday, October 2, 2010

Direct to Patient Reporting

On September 29, 2010 I wrote about a possible future solution to pre-examination phase error.  Today I am interested at the other end, all the problems associated with post-examination problems.  There are so many ways in which laboratories can and do mess up reporting.
We put out late reports, we lose reports, we send them out with the wrong patient name or wrong identifiers, we send the report to the right doctor with the write patient name on-time, but with the wrong information.  And we send out the right information on the right patient but to the wrong physician.  And we do it with incredible repetition and frequency.  It is disturbing how often an amended or corrected report has to go out. 

And the aforementioned doesn’t include how many confusing or ambiguous reports we send out because of our incorporated jargon and stultifying formats. 

Put them all together and the number of post-examination errors can usually run around 1-3 per thousand reports, assuming that we capture them all.  What is really scary is that in many situations, our saving grace is that most results are “normal” so that if we confuse one person’s “normal” result with another person’s normal result, we would never pick it up. 

But I saw an interesting development in an broadsheet that I get mailed to my home called “Canadian Healthcare Technology” – September 2010 (  They promote themselves as Canada’s magazine for managers and users of information systems in healthcare.  This edition has an interesting series of articles on Lean in healthcare.

More interesting, and more relevant to the topic of post-examination challenges is an article on page 8 about a system which allows patients to access their own laboratory results electronically and directly without going through a clinician or physician. 

Just reading the title made my quality antennae go up.  On the one hand I am kind of a “power-to-the-people” type guy and so the concept is pretty intriguing.  It goes to the question, whose urine is it anyways?  Who says we always need a doctor to read what is on the piece of paper, or the computer screen.

But on the other hand I am a clinician, physician, laboratorian, qualitologist, and my immediate second reaction was OMG!  Considering all the challenges we have with post-examination error at the best of time, and now we add on going direct to patient without an interpretive intermediary. And when the wrong person gets the wrong information on the wrong patient, we call that a breach of confidentiality.

It reminded me of another concept called Quality Partners, the groups with whom we routinely interact to ensure we get our quality right: standards development bodies, accreditation bodies, proficiency testing bodies, educators, professional organizations, equipment and reagents suppliers, and the Public.  We can probably continue to get along sending difficult to interpret results to the usually right and sometimes wrong physician, usually on-time, and sometimes not.  But I imagine that the public may see things a little differently.  As a student said, you can wake up the sleeping giant, but watch out.  You have no idea where and how things go from there.  (Not to overstate the obvious, but in this case, the sleeping giant is the collective general public which of course includes its media, legislation, regulation, and litigation constituents.

 I can see three outcomes; either this will fade away as a plan in which no one is interested, or it will force laboratories to re-look and re-consider their report writing policies and practices, or the litigators and regulators will have a field day.

So we will see.  Direct to patient reporting – the new normal, or the newly normal, or the beginning of a new “long and winding road that will lead to your door and never disappear”?

Who says that the road to quality improvement is always supposed to be easy.


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