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By Max Reiboldt
Managing Partner and CEO The Coker Group
02/19/08
One of the chief complaints of physicians in regards to clinical laboratories is that they cannot access the results of their patients’ labs as quickly as they need to. This is often not related to the clinical lab staff, who are working as efficiently as possible to process specimens, run the appropriate tests, and post results. These staff members require a set amount of time to perform their job while also ensuring that the highest levels of safety and quality are being upheld. The problem is not from the technician side, but rather is attributable to "lost-in-translation" laboratory results.
Once laboratory results have been processed and their results are ready for viewing, applicable physicians should have immediate access to these results. However, this accessibility has proven to be a problem within a fair amount of clinical laboratories and the greater healthcare systems of which they are a part. In many organizations today, lab results can reach a physician using an assortment of methods—results can be faxed to the physician’s private practice, mailed to their office, printed out at their office, or called back to the physician. However, the majority of these methods are driven by a person other than the physician. Other than the call-back method, in which physicians have made a request that they are to be notified of specific test results via telephone as soon as they become available, the other methods take a more passive approach to results reporting. In addition, these methods allow for the introduction of error into the reporting process, including delays due to busy customer-service representatives that cannot get to call-back reporting fast enough for the physicians, or no transmission of the reporting fax due to a down or busy fax line. It is necessary that a shift take place within the clinical laboratory mindset to allow for physician-driven result notification. Rather than waiting passively for test results to hit their mobile phone, office fax, or printer, physicians should be placed in the driver seat when it comes to their patients’ laboratory test results.
Clinical repositories may be the solution to this accessibility problem. Also known as portals, these systems allow physicians to log in to their healthcare systems’ laboratory-results database from a remote location, whether from the confines of their private practice or even their home. Using a secure login and password, physicians are able to search for the results they need when they need them. As soon as results have been processed and entered into the greater database, physicians can log in to the system and view these results. This decreases the time that would ordinarily be associated with waiting for the fax, postal letter, or printout to be received by a physician’s own office, and the corresponding time it takes to get the results from this form to a physician’s own eyes or ears. Therefore, allowing physicians access to a clinical repository enables these providers to view test results with a minimal time delay.
An application analyst with a large healthcare system in southeast Wisconsin is quick to extol the merits of a portal system. Physicians in this particular healthcare system utilize a Web-based remote-access portal for all laboratory results. To integrate into this system, physicians must first request access to the system. At this point, they complete forms with the business reason they desire such access and sign user-agreement forms. Once a physician’s paperwork has been processed, security measures are put in place, allowing each physician a unique login name and password. Communication is then sent to the physician via e-mail, including instructions on how to download a series of small software files to the hard drive of each computer he or she will be using to access laboratory results. This is a one-time-installation process, after which physicians are able to use their login and password to access laboratory test results from their home or office.
The benefits of such a system are numerous and varied. For physicians, the benefit is that they are able to access their patients’ test results any time of day or night, without waiting for another person to send them the results via phone, mail, or fax. For patients, the benefit is that their physicians are allowed ready access to lab results that can have a large clinical impact on their care. A physician within a large healthcare corporation in Cincinnati, Ohio, cannot emphasize the importance of timely reporting enough. "Non-timely clinical lab reporting is tantamount to malpractice in this day and age, where labs are life and death in clinical decision-making and play a significant role in patient’s morbidity and mortality," reports the physician. Obstetrical hemorrhages may be a reality for this physician’s patients if she does not have the results from labs to indicate her patient’s blood counts and coagulation levels. The disastrous and possibly fatal effects of an obstetrical hemorrhage highlight the importance of timely reporting of laboratory results and their subsequent impact on patient care.
Clinical laboratories are an important facet of healthcare delivery and a vital part of the healthcare team. While technicians within a laboratory may be working as efficiently as possible to deliver an expedited turnaround on all specimens received, a significant disconnect exists between the determination of results and the physicians’ notification of these results. Utilization of a clinical repository serves to diminish the wait time between when the results of a lab are available and when a physician is privy to them. By placing physicians in a position where they are able to proactively research laboratory results, portals help to speed the reporting process and ensure that patients continue to receive clinical care that is based on all available information in the shortest possible timeframe.
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