Communicating results from care
provider to patient.
The DCP results service forwards routine pathology and radiology results received by doctors, to patients. Thus, patients will not need to make telephone calls requesting results. Comments and guidance are included in the forwarded message.
Distributing results from tests is an essential element of communication with patients.
Patients will want to know their results and also want to know that the doctor has reviewed their results in the context of their care.
Drawbacks of allowing
Accepting telephone calls for result has several major drawbacks. Initially the patient will contact the front desk and the secretary will be required to determine if the result is available and then the action that is to be performed. The secretary is not able or qualified to discuss results with patients or provide details. The secretary's role therefore is to determine whether the results requires review via consultation or whether the result can be provided over the telephone and by the doctor(or nurse if available).
If the result is to be provided to the patient out of consultation context the GP will be required to discuss with the patient over the telephone the result of their tests. If the secretary patches the telephone call through it can potentially interrupt
consultation and interfere with the current work flow. If the secretary makes a note for the doctor to return a telephone call and discuss the results at a later time, time will need to be allotted.
Telephone discussion of even normal results will often turn into miniature consultations where the patient will prompt for discussion of other problems. Relay of results via telephone inevitably consumes more time than we have free time.
Dealing with Acute Symptoms.
When a patient is being investigated for acute symptoms it is appropriate to book a review consultation at the time pathology or radiology is ordered. The DCP results service is not intended to be used in this particular context as a mechanism of distributing results but can be used to augment communication and provide early delivery of results.
The DCP results service when implemented correctly will eradicate telephone calls received at the front desk for routine pathology and radiology results. When implemented correctly the doctor can be confident that routine results will be distributed via SMS and Internet, however if the service fails for any reason the worst-case scenario is that the patient will telephone the front desk to obtain their results. To ensure correct implementation it is imperative that all results deemed abnormal and requiring discussion are recalled by usual practice recall mechanisms outside the DCP results system.
There is no implied guarantee that the DCP results service will deliver results or that patients will access their results on-line even if the results service is delivering messages.
It is imperative to understand that at the heart of the service is a mechanism to prevent patients telephoning for routine results. It is not a service that guarantees delivery of messages, results or guidance. That guarantee is provided by the usual medical practice mechanisms for recalling patients requiring discussion of abnormal results.
For example, a patient with slightly elevated cholesterol that you have deemed warrants review (yet not significant enough to warrant urgent recall) must still be recalled for discussion of their slightly elevated cholesterol using the medical practice recall system.
Dealing with Sensitive results.
Sensitive results containing information deemed best handled via direct communication (for example an unexpected elevated prostate specific antigen in the context of routine investigations) can be handled within the DCP results system so that the result is not uploaded and the patient not notified
via SMS message.
This can be handled at two different stages within the process of checking results and uploading results.
The process of checking results begins in your clinical software when results are first imported. At this stage you can include a comment that begins with #R which will be detected by the DCP results system and the actual report will not be uploaded.
At the stage of uploading results to the DCP results server all results can be previewed/reviewed.
Individual results or complete patient sets of results can be marked "do not upload".
Work flow for using the DCP results service.
Firstly, when you order pathology for a patient or radiology, you must use the icon on the DCP panel to bring up the patient enrollment form. On the enrollment form there are several check-boxes which must be checked, indicating that you have consented the patient to receive their results through the service and that you have explained how the results system will function. You must validate the mobile telephone number and date of birth of the patient. Once you have consented explained and validated the enroll patient button is clicked.
Secondly, when checking results in clinical software and thus importing you will need to change your approach slightly. Patients who have been enrolled with the results service will be able to see your designation of the result-either no action, discuss or return. Patients will also be able to see the comments that you enter while checking results.
Comments will be uploaded with the test report.
At this stage you can include the #R to exclude the report or #C to exclude the comment.
After checking results into clinical software click on the green DCP results service icon on the DCP panel to open the results upload . At this stage you can review all results that will be uploaded and marked individual results or complete result sets for patients to "do not upload". It will also be able to change or amend comments at this stage. Once you
are satisfied that the set of results to be uploaded is to your satisfaction click on the upload results button it will take up to 1 minute for the results to be uploaded.
Immediately upon uploading a set of results for a patient to the server, the server will send an SMS notification to the patient that new results are available to be viewed on-line. In the SMS notification there are instructions on going to the
website and a four digit pin code which will need to be entered into the website along with patients date of birth and mobile telephone number.
Which Results will be available to be uploaded?
When you request a test and enroll a patient you are not enrolling the patients to receive the results of tests from that particular request but are in fact enrolling the patient to receive notification of results that are returned within a time period (three months).
Any results received in the three months that follow enrollment will appear in the set of results to upload to the Internet when using the DCP results service upload form. This includes results requested by other GPs within the practice or even consultants
ordering tests external to your medical practice. Results for tests requested by other persons will not be shown in the list by default but can be included by unchecking the pink check-box. If shown, results requested by other doctors will be highlighted pink in the list of results to upload on the DCP upload form.
Also results that are checked into clinical software by another GP on your behalf will appear in the set of results to be uploaded. These will be highlighted with a yellow background and there is a check-box on the upload form you can use to exclude these
results. This can be a cause for consternation if you are not aware of this technical limitation within the service.
Auditing and Review.
DCP allows you to review all results that have been uploaded in the previous three months. On the history list you will be able to click on a button beside the patient name in the list of results. This button opens the particular web page to which those results have been uploaded. This page will display results identical to the view patients are displayed after logging in to dcpresults.com.
Results uploaded for a patient are cumulative over time and will appear in the list of results to view.
This means that old results from greater than three months prior will be displayed. There will be options in the future for patients to remove tests from the list.
Cost to use the service.
The service is free to use for DCP subscribers with
the cost of SMS being rolled into the subscription
DCP Results Service