With recent news indicating that diagnostic imaging, pathology services and other diagnostic results will directly upload to the personally controlled electronic health record (PCEHR) I thought it timely to review and expose certain ideas and fundamental concerns.I firmly believe health consumers should have access to their own results.
It is a fundamental cornerstone of empowering and engaging with health consumers.General practitioners already disseminate results in a curated fashion particularly focusing on abnormal results. Often however, not all normal results are communicated directly to patients. This is perhaps a failing point which needs to be addressed. Health consumers in our current information rich society expect access to such basic information.With all the negative press and poor reception the PECHR has received, not to mention the wasted millions of dollars, there would be significant pressure for the achievement of something/ anything! Disseminating pathology results directly from test providers is simply picking the low-lying fruit. It is technically achievable via connecting health investigative services to the PCEHR. Without any intervention, oversight, input from health providers it is an easy way for the PCEHR to achieve something visible to consumers. However this is a wasted opportunity for engagement and provides significant risk of misinterpretation of result reporting. In my 24 years of general practice and emergency medicine, one of the most problematic areas fraught with potential to engender anxiety among health consumers is exposure to unfettered/raw results. From this anxiety often stems angst, needless worry, often with construction of a barrier between the health consumer and the health provider. Consumers will rush to consult the Internet often with the consequence that their anxiety is multiplied. Many times consumers seek consultation with the original provider or alternative health providers to discuss trivial issues related to result reports considered by the health provider to be irrelevant to actual provision of care. Significantly abnormal results represent an issue requiring deft handling with explanation only available through direct consultation, Not on-line.Uploading results directly from the diagnostic imaging or pathology service to the PCEHR provides no feedback/audit/review process for the ordering practitioner.
The process of consenting patients seems to be missing in action. There is no thought to the suitability of individual results being displayed directly to patients. The whole process is a cross cutting concern implemented by health workflow naive PCEHR creators. It sidelines general practitioners and other health providers and is essentially side-lining health consumer care.
Over the past few years I have pondered, devised and finally created a mechanism for distributing results online. Distributing results in a fashion which overcomes all the above concerns, is technically feasible and more importantly provides value to both health providers and health consumers. Distribution in an orchestrated doctor controlled workflow providing immediate notification, audit and review et cetera has been very successful as evidenced by the fact that over 1 million pathology and imaging results have now been distributed!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.