Re: Calling or e-mailing lab reports to patients - Does it provide true value?

[Guest guest]

That is not a smart way to handle labs/test results, ask your malpractice

carrier. If somehow a result is abnormal but slips through the cracks somehow &

the results are not conveyed to the patient (and you told them not to call), you

are finished. You should convey ALL results, normal or abnormal, to the

patient.

>

>

> Date: 2007/01/01 Mon PM 07:02:17 EST

> To:

> Subject: Calling or e-mailing lab reports to patients -

Does it provide true value?

>

> I practice in BC, Canada. I tell my patients I will only contact them

> when tests are abnormal. I believe this saves an enormous amount of

> time. Most MD's in BC do it this way. We are paid about $24 US per

> visit, by the way.

> Routinely contacting patients regarding normal values strikes me as a

> waste of time. I explain to the patients what I expect the tests will

> show and give advice based on that. If results don't support my

> preliminary advice then I will call the patient, explain the

> unexpected results and adjust the advice.

> Would such a strategy work where you practice?

>

> Jeff Harries

> Penticton, B.C.

>

>

>

[Guest guest]

One

strategy to decrease the calls you have to make is to have patients get their

labs done a day or so before their appointment. That way you can discuss them

at their appointment. That only works for routine labs done for cholesterol,

etc., and not acute illness.

Dan

Calling or e-mailing lab reports to

patients - Does it provide true value?

>

> Routinely contacting patients regarding normal values strikes me as a

> waste of time

[Guest guest]

RE Sending results to pts, normal or not.

OK, guess there might be a disconnect here.

1) Is there 1 unified database of results in Canada? Meaning, as a doc, will I get all results sent to me no matter what, and is there one place to look for them there?

For ex, if I ask a pt to get labs in 1 month, I might not get them, as they could go to the hospital lab (preferred, as I can access database if I know to look for them) but if goes to private lab, OR if they're sent to my old office (hospital owned), I might still not get them.

2) When working for hospital owned practice, I did informal survey, and found that 80% of pts wanted all results; those 20% who didn't want them "if normal," called within 2 weeks for the results. Only about 10% of total didn't care (as long as they got their refills, problem resolved, etc).

3) What got burdensome for the staff (paid by hospital) was the reporting of same. By that time, I'd put in my own self-funded EMR and printed out short notices the staff stuffed in envelopes (addressed by the EMR through windowed envelopes). I had an increasingly difficult time having staff track testing (even X-rays, CT scans, MRIs) and stopped doing the lab tracking, except for critical results.

At my own practice, now 2 years old, we track MRIs, CT scans, sonograms. Labs aren't tracked, except protimes drawn at the hospital, and with 15 pts/month following, this is still a big problem getting results.

We tell pts to call us in 1 week if they don't hear from us with ALL lab results, trying to get back to them within 3 working days. If pts will email us with date of draw, we'll get the results back within 2 days.

I have a pt panel of about 400; 2.5 FTEs working for me, ambulatory FP ages over 7, but I'd say 90% over 15 years old.

I consider the results back issue a practice builder, not an imposition.

I'd expect that when my base of active pts gets to 1000+, I'll mail more results like I did before (usually check-off list of "normal, see you in __ months as scheduled), but would like eventually to get to the point of using a secure site method.

As far as legalities go NOT calling pts, well, I've heard some legal opinions not to give ANY results over the phone as you're "not sure who you're talking to." I've had 1,2 pts in the last 2 years NOT want results, but almost all are happy to get the call. We do NOT leave results on any answering machine, just that we called.

Happy to swap war stories with a Canadian Doc up north.

Dr Matt Levin

2 years solo

FP trained 1988 residency

Calling or e-mailing lab reports to patients - Does it provide true value?> > I practice in BC, Canada. I tell my patients I will only contact them> when tests are abnormal. I believe this saves an enormous amount of> time. Most MD's in BC do it this way. We are paid about $24 US per> visit, by the way. > Routinely contacting patients regarding normal values strikes me as a> waste of time. I explain to the patients what I expect the tests will> show and give advice based on that. If results don't support my> preliminary advice then I will call the patient, explain the> unexpected results and adjust the advice.> Would such a strategy work where you practice?> > Jeff Harries> Penticton, B.C.> > >

[Guest guest]

My main concern with that sort of system

is that you need to have good tracking to make sure the lab result came in, not

an easy feat to accomplish (even though we are supposed to), that I do, but

with lots of effort. Having the patients expect a result from me helps to

make sure I’ve gotten the results and passed them on. I’ve

had many patients come from other practices where they were told ‘no news

is good news’ (ie, results are assumed to be normal if they are not

called), when they actually had very abnormal results (enough to warrant

further investigation/med change, etc) and were never contacted. I’ve

had other patients that were not able to get their lab results, even though

they wanted them, without becoming extreme pests (numerous calls to their

doctor, writing letters, going in to the office to pick up the results, etc). I’ve

found that most people appreciate the reassurance that their labs were indeed

normal. Maybe difference in climates (malpractice, expectations, etc) between

the US and Canada. I

do know docs here that do exactly as you describe, but that is not ideal in my

mind. My 2 cents worth.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From:

[mailto: ] On

Behalf Of jeff_harries

Sent: Monday, January 01, 2007

5:02 PM

To:

Subject:

Calling or e-mailing lab reports to patients - Does it provide true value?

I practice in BC, Canada. I tell my patients I will

only contact them

when tests are abnormal. I believe this saves an enormous amount of

time. Most MD's in BC do it this way. We are paid about $24 US per

visit, by the way.

Routinely contacting patients regarding normal values strikes me as a

waste of time. I explain to the patients what I expect the tests will

show and give advice based on that. If results don't support my

preliminary advice then I will call the patient, explain the

unexpected results and adjust the advice.

Would such a strategy work where you practice?

Jeff Harries

Penticton, B.C.

[Guest guest]

This is where innovations in work flow can help. Lynn Ho notes that

asynchronous communication is more time effective for her.

Clemensen and others use UpDox to send notification to pts. New

technology linked to new process not only reduces work burden, but

improves our communication. I would not be surprised to find a

lower volume of phone calls per pt population in Clemensen's practice

when compared to a practice notifying by snail mail, or notifying only

with abnormals (see the strong desire for communication in Levin's

informal poll below).

Gordon

At 08:55 PM 1/1/2007, you wrote:

RE Sending results

to pts, normal or not.

OK, guess there might be a disconnect here.

1) Is there 1 unified database of results in Canada?

Meaning, as a doc, will I get all results sent to me no matter what, and

is there one place to look for them there?

For ex, if I ask a pt to get labs in 1 month, I might not

get them, as they could go to the hospital lab (preferred, as I can

access database if I know to look for them) but if goes to private lab,

OR if they're sent to my old office (hospital owned), I might still not

get them.

2) When working for hospital owned practice, I did informal

survey, and found that 80% of pts wanted all results; those 20% who

didn't want them " if normal, " called within 2 weeks for the

results. Only about 10% of total didn't care (as long as they got

their refills, problem resolved, etc).

3) What got burdensome for the staff (paid by hospital) was

the reporting of same. By that time, I'd put in my own self-funded

EMR and printed out short notices the staff stuffed in envelopes

(addressed by the EMR through windowed envelopes). I had an

increasingly difficult time having staff track testing (even X-rays, CT

scans, MRIs) and stopped doing the lab tracking, except for critical

results.

At my own practice, now 2 years old, we track MRIs, CT

scans, sonograms. Labs aren't tracked, except protimes drawn at the

hospital, and with 15 pts/month following, this is still a big problem

getting results.

We tell pts to call us in 1 week if they don't hear from us

with ALL lab results, trying to get back to them within 3 working

days. If pts will email us with date of draw, we'll get the results

back within 2 days.

I have a pt panel of about 400; 2.5 FTEs working for me,

ambulatory FP ages over 7, but I'd say 90% over 15 years old.

I consider the results back issue a practice builder, not an

imposition.

I'd expect that when my base of active pts gets to 1000+,

I'll mail more results like I did before (usually check-off list of

" normal, see you in __ months as scheduled), but would like

eventually to get to the point of using a secure site method.

As far as legalities go NOT calling pts, well, I've heard

some legal opinions not to give ANY results over the phone as you're

" not sure who you're talking to. " I've had 1,2 pts in the

last 2 years NOT want results, but almost all are happy to get the

call. We do NOT leave results on any answering machine, just that

we called.

Happy to swap war stories with a Canadian Doc up north.

Dr Matt Levin

2 years solo

FP trained 1988 residency

Calling or e-mailing lab reports

to patients - Does it provide true value?

>

> I practice in BC, Canada. I tell my patients I will only contact

them

> when tests are abnormal. I believe this saves an enormous amount

of

> time. Most MD's in BC do it this way. We are paid about $24 US

per

> visit, by the way.

> Routinely contacting patients regarding normal values strikes me

as a

> waste of time. I explain to the patients what I expect the tests

will

> show and give advice based on that. If results don't support

my

> preliminary advice then I will call the patient, explain

the

> unexpected results and adjust the advice.

> Would such a strategy work where you practice?

>

> Jeff Harries

> Penticton, B.C.

>

>

>

[Guest guest]

From the MD in Drain, Oregon; Managing lab reports: To add to the data base: I have all my patients follow up on their labs or CTs or ultrasounds etc with an office visit: most of them do and we review their medication lists at that time, taking home their printed results.. Some don't come in, and they are called, or I try to call them. For managing the results: I have collected the blood, (no one else for miles around to do it) so I also keep all the lab request copies filed on a shelf (also x-ray, etc), above which I have a set of 10 metal chart holders that some previous hospital had at one time. After I put the patient's results, action and contact in their EMR chart, I print the last name in big black letters on their results along with a note about their contact and their action recommended, initial it and put it in the alphabetized metal chart

holder on the wall, and put a dark x on the corner of their lab request. (Big letters because I decided these things got lost because we couldn't easily read who they belonged to with the tiny print on the lab sheets.) The patients all know they should come in and get the results. Usually they have made an appointment to go over them after which they take them away, but some couldn't come. So, they get them from us from the chart holder or they get a phone call from me about them. I go through the chart holder once a month and throw out all the old unpicked up cases, reviewing at that time to be sure something vital was not missed. That means I have 1; made an appointment to review the results 2: called or attempted to call them at least twice 3. kept the results for them for a month 4. reviewed and called again any patients with problems that needed to be

addressed. I have a 5 which I have not had to do: if anyone had real problems and could not be contacted, missed an appointment and also was not there with a later call: I could sent a registered letter, or go to their house which is probably down the street from me. Having the lab request copies with the accession numbers on a shelf behind me (with a HIPPA protecting barrier to viewing the names on the results) is useful when it comes to checking the lab for problems or failed faxing...I always have the numbers right there for them. And I know when nothing came on a patient because I have the copy there with no big dark X on the corner. Probably there is a high tech system to manage this, but I have fallen back on hard copy here in Drain, because many of my patients have never used email. For a lot of them, I am the first MD who has given them their own copies of the results.

Joanne __________________________________________________