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L. Casalino, D. Dunham, M. Chin, Rebecca Bielang, E. Kistner, T. Karrison, M. Ong, U. Sarkar, Margaret McLaughlin, D. Meltzer (2009)
Frequency of failure to inform patients of clinically significant outpatient test results.Archives of internal medicine, 169 12
The recent article in the Archives titled “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results”1 states that the use of an EMR does not improve physicians' ability to provide test results in a timely manner compared with paper records. The authors missed an opportunity, however, to point out one potential solution—give the patients access to their test results directly, using a personal health record (PHR) directly linked to the EMR. Many health systems are now using a linked patient portal to more closely involve patients in their care and share significant portions of their medical records. The “Meaningful Use Matrix” recently released in support of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 [Pub L No. 111-5, 123 Stat 115]) highlights the importance of providing patients with electronic access to their clinical information, including laboratory test results, by calling it out as one way to demonstrate full implementation of an electronic health record. At Kaiser Permanente, our members have viewed more than 85 million laboratory results online in the last 4 years. This number includes both normal and abnormal results. Physicians know that members who have access to their PHR can see their results; patients who have access are notified with an e-mail alert every time a new result is released or every time their physician adds a comment to a result. Kaiser Permanente members are able to see their results quickly and efficiently—much more so than when they had to hope they would be notified about their results. Because the study's authors did not include the possibility of direct patient access to their laboratory test results in the study methods, they missed an opportunity to demonstrate that, while an EMR alone may not reduce the volume of patients who are notified about negative test results, an EMR combined with a PHR that includes direct access to EMR data are likely to significantly increase notification percentages. More research needs to be done to fully investigate the impact of PHR access to health data. Of course, not all patients have access to computers, so even a system with an EMR combined with a PHR needs to provide an offline means of notifying patients of their abnormal results, such as letters or telephone calls. Access online is also no substitute for meaningful communication with patients about laboratory results, their interpretation, and next steps. Still, it is clear that PHR access to EMR data can have a notable impact on physicians' ability to notify patients about their clinically significant test results. Correspondence: Dr Christensen, One Kaiser Permanente, One Kaiser Plaza, 25th Floor Lakeside, Oakland, CA 94612 (kate.christensen@kp.org). References 1. Casalino LPDunham DChin MH et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med 2009;169 (12) 1123- 1129PubMedGoogle ScholarCrossref
Archives of Internal Medicine – American Medical Association
Published: Oct 26, 2009
Keywords: electronic medical records,personal health records,abnormal test results,laboratory test finding
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