Discussion Board

https://www.usnews.com/news/healthiest-communities/articles/2020-09-15/lost-and-misunderstood-test-results-harm-patients

Best,

Vinita

Vinita Parkash

Pathology, Yale School of Medicine

Cell 203-745-7170

Office: 203-785-6479

Thank you for sharing your commentary on this important topic.

In 2015 my institution (the University Medical Center Utrecht in the Netherlands) introduced real-time reporting of diagnostic test results to patients through an online patient portal. I remember the discussions and our fears, especially for anxiety of patients.

Colleagues from Utrecht recently wrote a nice paper regarding the question whether real-time access to the EHR by the patient is harmful? I think they discuss the pro's and con's very well.

It is freely available online through the link below.

Maarten ten Berg, clinical chemist, University Medical Center Utrecht

Thank you all for your feedback and comments. I am sure I have not fully considered all of the issues that might surround direct to patient reporting. I think that it is feasible for Pathology-which is a low volume and high impact field. We tend to be the last word in cancer diagnosis.  

Patient portals provide access but do not close the loop with respect to comprehension. A patient might see their report, their clinician may give the patient an explanation of the report, but that is a failed communication if the neither understood the import of the report/ diagnosis and the right action did not happen.  Technology (CDS, AI etc) will undoubtedly play a role in addressing this problem. But till that happens, this might work.

I think that the evidence that putting pathology reports on the patient portal will improve patient safety is very limited.   Obvious barriers are that patients have to view the portal , understand the report, and know what to do if they do understand the report.  In a study we did that put lab results on line for creatinine, we found that patients who actually viewed their test results only had a 2-10% lower chance of having their abnormal results not followed up (AJKD 74(5):589-600.)   This was statistically significant but not very large of an effect.

Having said all of this, the medical record is for the benefit of the patient and the patient should have unfettered access to their medical record.  In the pre-EMR days that meant going to medical records and physically obtaining a copy.  In today's environment we simply need to keep up with technology.  I would argue that posting results on the portal is not just a safety issue but an ethical issue and that we should not put barriers in the way of patients accessing information that they are entitled to see.

Michael H. Kanter, MD, CPPS

Professor and Chair

Department of Clinical Science

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