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Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

  • 1.  Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-16-2020 13:12

    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

     



  • 2.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-16-2020 14:30

    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


    Real-Time Access to Electronic Health Record via a Patient Portal: Is it Harmful? A Retrospective Observational Study.
    van Kuppenveld SI, van Os-Medendorp H, Tiemessen NA, van Delden JJ.
    J Med Internet Res. 2020 Feb 6;22(2):e13622. doi: 10.2196/13622.
    PMID: 32044753





  • 3.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-16-2020 16:49

    Thank you. Also for the link to the paper.

     

    Vinita. 

     

     






  • 4.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-17-2020 11:49

    "The medical profession must end its refusal to allow direct reporting of significant test results to patients from pathologists and radiologists."

    This is among the top 3 solutions to improving patient safety - and reducing the incidence of medical malpractice lawsuits. Only concern is that a large percentage of patients never access their patient portal.



    ------------------------------
    Charles Pilcher MD FACEP
    Chair, Board Quality & Safety Committee
    EvergreenHealth
    Kirkland, WA
    Editor, Medical Malpractice Insights - Learning from Lawsuits
    https://madmimi.com/p/5f4487
    ------------------------------



  • 5.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-17-2020 12:11
    As a patient advocate, I concur wholeheartedly.  My Stage IV cancer might have been found sooner, had I only seen two simple document, one which indicated I needed to see a hematologist, and another which indicated that my 'tiny, scabbed over stomach ulcer' did NOT exist.

    Many thanks from many, many patients for this stance.
    Peggy Zuckerman
    www.peggyRCC.com





  • 6.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-18-2020 11:25

    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.

     






  • 7.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-18-2020 11:52
    You say patient portal.   But the reality is portalS

    I've got 11.  About 5 or 6 docs,  3 or 4 pharmacies, medicare, my private insurance (blue)      and one mail order pharm for no deductible (but cheaper) has other lists.  (so i guess 12 portals) 

    The data are gaga.  They say I've been on about 9 PPTs at the same time...and for years.... and continue to be.  Drugs I tried but didn't work are still on.   The problem lists have about a .6 relationship to each other.     a few say they don't know my gender at birth.  my ht has dropped 2 inches (may well be true), a few give my wt when I was 25 lbs more than now.   i'm a never smoker, past smoker, or smoker.   (I naturally smoked a pipe when i got my PhD but have not used it in 40 years) 

    note that although i'm prof of med informatics at two universities, I've never been able to correct a single item.  i've tried.



    Ross Koppel, Ph.D. FACMI, UNIV. OF PENNSYLVANIA

    Prof. of Biomedical Informatics, Perelman Sch of Medicine.

    Senior Fellow, Wharton's Leonard Davis Institute of Healthcare Economics;    

    Senior Fellow, Center for Public Health Initiatives, Perelman Sch of Medicine; 

    Adjunct Professor (full) Sociology Department;    

    Affil Prof of Medicine, Perelman Sch of Medicine;  

    Prof. of Biomedical Informatics, SUNY@Buffalo    

    rkoppel@sas.upenn.edu







  • 8.  RE: Sharing link to my Op-ed in US News and World Report on patient harm from lost and misunderstood test results

    Posted 09-18-2020 11:58

    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

     

    98 S. Los Robles Avenue, Pasadena, CA  91101

    Work phone: (626) 564-3643 | tieline 8+338 | Mobile phone: (626) 243-8674

    michael.h.kanter@kp.org | https://medschool.kp.org | @michaelkantermd

    Pronouns: he/him

     

    Vanessa Papatsos, Executive Assistant

    vanessa.papatsos@kp.org | Work phone: (626) 564-3608 | Mobile phone: (626) 660-8604

     

     

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